Get Extra Help Paying Your Medicare Drug Costs
Extra Help is a Medicare program to help people with limited income and resources pay for their Medicare prescription drug coverage, such as plan premiums, deductibles, copays or coinsurance. Additionally, those who qualify will not have a coverage gap or late enrollment penalty.
Depending on your income level, you may pay less or pay nothing for your plan premium and yearly deductible. In 2021, drug costs are no more than:
- $3.70 for each generic drug
- $9.20 for each brand-name covered
These amounts may change in 2022.
Do I qualify for Extra Help?
In 2021, you may qualify if you have up to $19,320 in yearly income ($26,130 for a married couple) and up to $14,790 in resources ($29,520 for a married couple). These amounts may change in 2022.
To see if you qualify, call:
- Social Security at 1-800-772-1213 (TTY users call 1-800-325-0778).
- Your state Medicaid office.
View valid evidence of low-income eligibility (Best Available Evidence, BAE).
Get more information on Best Available Evidence (BAE) from Medicare.
Extra Help Details
If you get Extra Help from Medicare to pay for your Medicare Prescription Drug Plan costs, your monthly Part D plan premium may be lower than what it would be if you did not get Extra Help from Medicare. The amount of Extra Help you get will determine your total monthly Part D plan premium as a member of our plan.
You must continue to pay your Medicare Part B premium (unless your Part B premium is paid for you by Medicaid or another third party).
Premiums, deductibles and co-payments may vary based on the level of Extra Help you receive. Contact us for details.
State Pharmacy Assistance Programs
A State Pharmaceutical Assistance Program (SPAP) helps people pay their monthly prescription drug plan premiums, deductibles, co-payments and coinsurance. For most programs, members must meet specific criteria to be eligible
To find out if there is an SPAP in your state, please review the Evidence of Coverage or call your State Health Insurance Assistance Program (SHIP).
Medicaid is a joint federal and state program that helps pay medical costs for some people with limited income and resources.
- Most health care costs are covered if you have Medicare and Medicaid.
- Medicaid programs (and income limits) vary from state to state.
- Medicaid may offer coverage for services that aren’t fully covered by Medicare, such as nursing home and home health care.