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Medicare Prescription Costs too High? Get Some Extra Help

It’s no surprise that prescription drug costs can really start to add up. Every day, it seems like we’re paying out-of-pocket more and more for the medications we need. Sometimes, even our standard Medicare prescription plans aren’t enough. If you need assistance paying for your prescription drugs, there’s another way. The Medicare Extra Help plan might be for you.

What is the Extra Help program?

Extra Help, also known as the Part D Low-Income Subsidy (LIS), is a federal program that helps individuals pay for some of the out-of-pocket expenses associated with Medicare prescription drug coverage. It, however, is not a plan on its own; you must still have a Part D plan in order to benefit from Extra Help assistance.

Extra Help provides financial assistance to people with limited resources and income for costs related to a Medicare prescription drug plan—monthly premiums, annual deductibles, and prescription co-payments. With this plan, you will either pay the Extra Help copay or your plan’s copay for your prescription drugs. You will always pay whichever cost is lower. With full Extra Help coverage, you will pay no more than $3.60 for each generic prescription and $8.95 for each brand-name.

Here is what else Extra Help can do for you:

  • Pays for a portion of your Part D premium
  • Lowers the costs of your prescription drugs
  • Allows you to take advantage of a Special Enrollment Period
  • Eliminates any Part D late enrollment penalty 

A gap in Medicare Part D coverage is sometimes referred to as a donut hole. This means that at certain times you may have limited drug coverage and high costs. If you are eligible for Extra Help coverage, however, there is no donut hole and your prescription drug costs will remain consistent throughout the year. This will only change if you reach the Catastrophic Coverage stage of your Medicare Part D plan. This means that if you exceed the annual threshold of $6,550, your drug costs will be greatly reduced.

Should I enroll in Extra Help?

To qualify for Extra Help, you must be a Medicare-qualified individual with income and assets below a certain threshold ($1,615 monthly income for individuals and $2,175 for couples). If you are enrolled in Medicaid, Supplemental Security Income, or a Medicare Savings Program, you automatically qualify for Extra Help.

When considering Extra Help or any other Medicare drug plan, there are a few things you need to keep in mind:

  • The coverage of your prescriptions. These Medicare plans will often have a list of drugs covered by the plan. You will need to check to ensure that all your medications are covered. 
  • The costs of premiums, copayments, and other related expenses. The good news, though, is that if you qualify for Extra Help because of limited income, you will receive assistance with these costs. 
  • Convenience in terms of location. Medicare drug plans contract with pharmacies in your area. You will have to check with the plan to ensure that your pharmacy is included.

If you already have some form of prescription drug coverage, you will have to evaluate your options by looking at your costs and coverage before deciding whether or not to continue with your current coverage or switch to Part D and Extra Help.

Extra Help is not for everyone. Talk with a Medicare professional to go over your options and determine if Extra Help is right for you. They can also help you get the process of enrolling started by filling out a Medicare Extra Help application.

The Medicare Policy Center is here to help you get the Medicare coverage you need.

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