Medicare has announced eligibility guidance for the Extra Help program, which helps individuals with their prescription drug costs. Medicare’s Low Income Subsidy (LIS) limits determine what level of support seniors can receive. Budgets are getting tighter with increased prices and inflation, and the Extra Help program can be a difference-maker for some of your clients. Understanding these limits is an important first step in the process.
What Is Extra Help?
The Medicare prescription drug program is an option for seniors that offers varying drug coverages. Qualifying seniors can apply for Extra Help to pay for their monthly premiums, deductibles and copayments that relate to the Medicare prescription drug program. In order to be eligible for Extra Help, seniors must be enrolled in a Medicare prescription drug program.
Eligibility to Get “Extra Help”
The Extra Help program is offered for clients that have already enrolled in a Medicare prescription drug coverage program. They must be enrolled in Medicare (Part A and/or B), live in the 50 states and meet the Low-Income Subsidy (LIS) requirements.
CMS has issued a memo on 2022 resource and cost-sharing limits. According to the memo, the 2022 resource limits for the full low-income subsidy are $12,600 if married and $8,400 if single. For the partial low-income subsidies, the limits are $27,950 if married and $14,010 if single. Applicants can add $1,500 for an individual or $3,000 for a couple to their resource limits if they have informed the Social Security Administration that the funds have been set aside for burial expenses.
In addition to the asset limits, there are also income limits, and Hawaii and Alaska have slightly different limits. A good indicator that clients qualify is if they have full Medicaid coverage, get help paying for their Medicare Part B from their state’s Medicaid program or get Supplemental Security Income (SSI) benefits. For more information on the asset and income eligibility requirements, see the LIS Eligibility Chart from the National Council on Aging.
Full or Partial Extra Help Coverage
Depending on your client’s eligibility, they can qualify for full Extra Help or partial Extra Help. Medicare says that the full Extra Help program provides no premium, no deductible and copays of no more than $3.95 for generic and $9.85 for brand-name prescriptions in 2022. The partial Extra Help program provides a reduced premium, a low annual deductible and copays of no more than 15% of the costs of drugs on the plan’s formulary until the out-of-pocket limit is reached.
How to Help Clients Apply for Extra Help
Gathering the financial documents needed to apply can be time-consuming, but the application is free. The Social Security Administration will request information about the income and resources listed above. Here is a great resource from the Social Security Administration that gives a comprehensive list and information on what you’ll need. While the application can be overwhelming, the program ultimately saves your clients money.
Where and When to Apply
Clients can apply to the Extra Help program once each year, with no specific enrollment period to follow. Clients can contact the Social Security Administration, which operates the program. Call 1-800-772-1213 (TTY 1-800-325-0778) or go to the Social Security Administration website.
Arizona residents who are struggling to afford healthcare should also contact the Arizona Health Care Cost Containment System (AHCCS). Eligible individuals can join one of three Medicare Savings Programs: Specified Low-Income Medicare Beneficiary (SLMB), Qualified Individual-1 (QI-1) and Qualified Medicare Beneficiary (QMB). See the AHCCS Eligibility Requirements for more information.
We’re here to help. If you have any questions, need guidance or want to know creative ways to get clients Extra Help, contact us today.
