Medicare's Extra Help Program for Prescription Drug Costs

Medicare's Part D prescription drug program still leaves many people with large out-of-pocket expenses for their drugs.  Some drugs have high copayments, and Medicare's Coverage Gap, also known as the "Donut Hole," can leave you with big drug bills.

 

Medicare has created the Extra Help program for low-income seniors who need assistance with prescription drug costs.  Application for this program is made through the Social Security Administration (see link at the bottom of this page to SSA's online enrollment application).  Below is an overview of some of the features of this program.

 

  • To qualify for extra help with Medicare prescription drug plan costs in 2016, your annual income must be limited to $17,655 for an individual ($23,895 for a married couple living together).  Even if your annual income is higher, you still may be able to get some help. A couple of situations in which your income may be higher than these limits are if you or your spouse support other family members who live with you, or if you have earnings from work.

 

  • In addition to the income limit, your total resources must be limited to $13,640 for an individual ($27,250 for a married couple living together). However, not everything counts toward the resource limit.  Some exclusions include your primary residence, your personal possessions, your vehicles, resources you could not easily convert to cash such as jewelry or home furnishings, property you need for self-support, such as rental property or land you use to grow produce for home consumption, non-business property essential to your self-support, life insurance policies, and burial expenses. This list is not exhaustive.

 

  • The Extra Help application for Texas includes a box for you to decline having your application sent to the state of Texas for Medicare Savings program consideration.  Leave that box unchecked.  That will cause your application to be considered for the Extra Help program for prescriptions and the Medicare Savings Program (MSP).  Income and resource limits are lower for MSP than for Extra Help; but if you qualify for both, you'll not only get help with your medication costs, you'll also no longer have to pay the Part B premium.

 

  • You may apply for Extra Help and MSP in one of two ways.  To apply online, go to www.ssa.gov/prescriptionhelp.  To submit a paper application, call SSA at (800) 772-1213.  Ask to be sent form SSA-1020.  Whether you apply online or by paper application, see the Medicare Publications page of our website for instructions on completing the application.  Of course, you're always welcome to call us for guidance on this or any matters related to Medicare or Social Security.