Extra Help from Medicare

The government created the Extra Help program to help people with limited incomes pay for Medicare Part D coverage. If you qualify, you'll pay less for monthly premiums and have reduced or no copayments for prescription drugs. In addition, people with Medicare who qualify for Extra Help will be covered in the coverage gap and will not pay a Part D late enrollment penalty.

Who is eligible for Extra Help?

Some people are automatically eligible, while others must apply.

    You automatically qualify if you have one of the following:
  • Both Medicare and Medicaid.
  • Help from Medicaid paying your Medicare Part B premiums (for instance, you belong to a Medicare Savings Program).
  • Both Medicare and Supplemental Security Income (SSI) benefits.

You should apply for Extra Help if you have the following income and resources:

Status

2019 Income

Resources

Single Less than $18,735 Less than $14,390
Married (living with spouse) Less than $25,365 Less than $28,720

Status

Single

2019 Income

Less than $18,735

Resources

Less than $14,390

Status

Married (living with spouse)

2019 Income

Less than $25,365

Resources

Less than $28,720

Note: Resources include your savings and stocks, but not your home or car or the value of any life insurance you may have. The above amounts are for 2019 and may change in 2020. If your income and resources are slightly higher, you should still apply.

Note: Resources include your savings and stocks, but not your home or car or the value of any life insurance you may have. The above amounts are for 2019 and may change in 2020. If your income and resources are slightly higher, you should still apply.

Blue MedicareRx premiums with Extra Help

The amount for your monthly premium will depend on the amount of Extra Help you receive.

Your Level of Extra Help

Monthly Premiums for Blue MedicareRx Premier (PDP)1

Monthly Premiums for Blue MedicareRx Value Plus (PDP)1

100% $91.70 $1.60
75% $100.70 $10.60
50% $109.80 $19.70
25% $118.80 $28.70

Your Level of Extra Help

100%

Monthly Premiums for Blue MedicareRx Premier (PDP)1

$91.70

Monthly Premiums for Blue MedicareRx Value Plus (PDP)1

$1.60

Your Level of Extra Help

75%

Monthly Premiums for Blue MedicareRx Premier (PDP)1

$100.70

Monthly Premiums for Blue MedicareRx Value Plus (PDP)1

$10.60

Your Level of Extra Help

50%

Monthly Premiums for Blue MedicareRx Premier (PDP)1

$109.80

Monthly Premiums for Blue MedicareRx Value Plus (PDP)1

$19.70

Your Level of Extra Help

25%

Monthly Premiums for Blue MedicareRx Premier (PDP)1

$118.80

Monthly Premiums for Blue MedicareRx Value Plus (PDP)1

$28.70

This table shows you what your monthly plan premium will be if you get Extra Help

If you qualify for Extra Help, Medicare will tell us how much assistance you will receive when you enroll in our plan, and we'll inform you of the amount you'll be responsible for paying.

How to apply for Extra Help

To see if you qualify, choose one of the following methods:

  • Call 1-800-MEDICARE (1-800-633-4227), 24 hours a day, 7 days a week. TTY users should call 1-877-486-2048.
  • Call your State Medicaid Office or the Social Security Administration at 1-800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday. TTY users should call 1-800-325-0778.
  • Apply on the Social Security Administration's website.
  • Visit your State Medicaid office.

How to complete the Extra Help application form

The Social Security Administration encourages you to get help from family members, caregivers, and other third parties.

Get ready by following these steps:

  1. Identify the major assets you own alone, with your spouse or with someone else, but do not include your home, vehicles, burial plots, or personal possessions.
  2. Review all your income.
  3. Gather your records in advance to save time.
      The records you will need are:
    • Statements that show your account balances at banks, credit unions, or other financial institutions.
    • Investment statements.
    • Life insurance policy statements.
    • Stock certificates.
    • Tax returns.
    • Pension award letters.
    • Payroll slips.

What if I've been told I no longer qualify for Extra Help?

You may still qualify for Extra Help, but you must re-apply to find out. You have the right to appeal the decision. To file an appeal, you will need to download, complete, and submit an Appeal of Determination for Extra Help with Medicare Prescription Drug Plan Costs (PDF) form from Social Security.

How often do I need to re-apply for Extra Help?

Social Security will review your eligibility every year. You do not need to re-apply unless you are notified that you no longer qualify for Extra Help.

1This does not include any Medicare Part B premium you may pay. Back