Extra Help with Medicare Prescription Drug Plan Costs

Extra Help with Medicare Prescription Drug Plan Costs

People with Medicare who have a low income and assets may be eligible for the Low-Income Subsidy (LIS), often known as "Extra Help," which can help with prescription drug prices. The benefit is provided by the Social Security Administration (SSA) and the Centers for Medicare & Medicaid Services (CMS).

Some folks are automatically given Extra Help. People who are dual-eligible for Medicaid and Medicare, commonly referred to as dual eligibles, those who get Supplemental Security Income (SSI), and those who qualify for the Medicare Savings Program are among them (MSP).

Anyone who is not already enrolled in the above-mentioned benefits must apply for Extra Help with the Social Security Administration.


How Does Medicare Extra Help Work?


A beneficiary's Extra Help amount is determined by their income and resources. Beneficiaries will either receive a full or partial subsidy. The majority of persons who are eligible for Extra Help will pay:

In 2021, each drug covered by their plan will cost no more than $9.20. Visit Medicare.gov for additional information.

There are no premiums,

There are no deductibles unless you receive a partial subsidy


Beneficiaries receiving Extra Help enjoy the following protections in addition to lower out-of-pocket costs:


A three-month Special Enrollment Period (between January and September, and once during Annual Open Enrollment) to join or switch Medicare Part D drug coverage throughout the year. These options allow Extra Help recipients to change plans without having to wait until the Annual Open Enrollment Period (Oct. 15–Dec. 7) to do so. Any modifications to your plan made outside of the Annual Open Enrollment Period will take effect the following month.

There is no penalty for enrolling late in Part D, even if the beneficiary enrolls late (that is, after they were first eligible to join a Part D plan and if they did not have other drug coverage).



What Personal Assets Are Considered Eligible?


Property that is not your primary residence

Stocks and bonds, including savings bonds issued by the United States

IRAs and mutual funds

Cash and bank accounts, such as checking and savings accounts, as well as certificates of deposit


Useful Topics

When And How to Apply for Medicare Part D?

Does a Medicare Drug Plan Cover Over-the-Counter Drugs?


Understanding what is and is not computed can assist you in determining if you are eligible for Medicare Extra assistance. Resources such as your principal residence, insurance policies, and a car are not counted by Medicare. Many folks are indeed eligible but are unaware of it. There are no repercussions for submitting an application to determine if you qualify.


What is the process for applying for Medicare Extra Help?


Fill out an “Application for Extra Help with Medicare Prescription Drug Plan Costs” (SSA-1020) form with the Social Security Administration to apply for the Medicare Low-Income Subsidy (LIS) (SSA). This form can be filled out and submitted by:


Requesting an application be mailed to you or apply over the phone by calling Social Security at 1-800-772-1213 (TTY 1-800-325-0778). Monday through Friday, from 7 a.m. to 7 p.m., Social Security representatives are available via phone.

Applying in person at a Social Security office near you.

Filling out an online application at www.socialsecurity.gov/extrahelp.


If you are eligible, the Social Security Administration will review your application and send you a notification in the mail. You can enroll in a Medicare Part D Prescription Drug Plan if you qualify for Extra Help and have not done so already.


For More Info About Your Coverage






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