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How to Help Clients Save $ on Prescriptions with Low Income Subsidies

Posted by Jean A. Lentsch on 6/25/19 2:57 PM

low-income-subsidies

Low income subsidies can help Medicare beneficiaries pay for their prescriptions. Navigating the system can be difficult, however. There are so many rules and so many notices. Agents can help their clients understand what they need to do to receive the help they deserve.

Understanding Low Income Subsidies

Also called Extra Help, the Medicare low income subsidy helps eligible beneficiaries with the out-of-pocket costs associated with Medicare Part D prescription drugs. There are different levels of Extra Help.

  • Beneficiaries who qualify for full Extra Help in 2019 should pay no more than $3.40 for generic prescriptions and $8.50 for brand-name prescriptions.
  • Beneficiaries who qualify for partial Extra Help will pay no more than 15 percent of the cost of prescriptions on the plan’s formulary.
  • Most beneficiaries who qualify for Extra Help also qualify to pay nothing in premiums and deductibles for Medicare Part D.

Some beneficiaries are automatically eligible for and enrolled in Extra Help. Other beneficiaries have to apply.  To be eligible, you should meet basic requirements, including having resources and annual income at or below the limit.

  • Savings, investments and real estate are worth $28,720 or less for a married couple living together, or $14,390 or less for an individual. Certain resources, such as a person’s home or car, are not included in the calculation.
  • Annual income is $25,365 or less for a married couple living together or $18,735 for an individual.

However, beneficiaries with a slightly higher income and resources may still qualify for some help. Additionally, limits may increase from year to year.  If your clients are not sure whether they qualify, you should encourage them to go ahead and apply.

Once beneficiaries have been approved for Extra Help, they should contact their plan with the information to make sure they are not overpaying.

Completing the Application

Beneficiaries can apply for Extra Help in one of three ways.

  • They can apply online at socialsecurity.gov/extrahelp.
  • They can call Social Security at 1-800-772-1213 (TTY 1-800-325-0078).
  • They can go to their local Social Security office.

To complete the application, beneficiaries will need to know their income and resources. It’s helpful to gather relevant documents, such as tax returns, payroll slips, bank statements, investment statements and stock certificates, ahead of time. This will simplify the application process.   

Why is it Important to Share this Information with Your Clients?

So many seniors struggle to afford their prescriptions. You will win a customer for life if you can solve this financial stress for them by recommending the Extra Help program. This is one more way to differentiate yourself as a client advocate.

Topics: low income subsidies, Medicare Part D

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