Extra Help
Extra Help Medicare Part D
Our federal government offers help with paying for your Part D drug plan expenses if you qualify based on income. This is called the Low-Income Subsidy. Anyone can apply for this at Social Security at any time, but help is awarded based on proving low-income and limited resources. You must have an annual income that falls below 150% of the Federal Poverty Level based on your household size.
Beneficiaries who qualify will receive assistance with paying their monthly Part D premiums, their annual Part D deductible, and also their co-payments for retail medications. There are different levels of qualification, and the subsidy level generally determines how much assistance you will get with premiums. Someone qualifying a full subsidy would have 100% of their Part D premium paid for, up to the benchmark allowed by Medicare for that year.

For example, if you get an award notice that says you have a full subsidy, and the benchmark for the year is $34, then you can choose any drug plan you like, and the LIS program will pay up to $34/month toward your premiums. Choosing a drug plan with a premium of $34 or less in that scenario would mean you pay nothing for your drug plan. Furthermore, you will pay no deductible if your plan has one, and your copays for medications are greatly reduced. If you think you may qualify, it is worth contacting Social Security for an application.
Extra Help Comparison Chart
If you have Medicare and Medicaid and/or a Medicare Savings Program | |||
---|---|---|---|
You are enrolled in... | And your income is... | Then you get... | Your 2017 copays are... |
Medicaid | Up to $1010 ($1,355 for couples) per month in 2017 | Full Extra Help $0 premium and deductible |
$1.20 generic copay $3.70 brand-name copay No copay after $4,950 in out of pocket drug costs |
Medicaid and/or the Medicare Savings Program | Above $1010 ($1,355 for couples) per month in 2017 | Full Extra Help $0 premium and deductible |
$3.30 generic copay $8.25 brand-name copay No copay after $4,950 in out of pocket drug costs |
If you have Medicare Only | |||
And your income is... | And your assets are... | Then you can get... | Your 2017 copays are... |
Up to $1,356 ($1,822 for couples) per month in 2017 | Up to $8,890 ($14,090 for couples) in 2017 | Full Extra Help $0 premium and deductible |
$3.30 generic copay $8.25 brand-name copay No copay after $4,950 in out of pocket drug costs |
Below $1,505 ($2,022 for couples) per month in 2017 And your income and/or assets are above Full Extra Help Limits |
Up to $13,820 ($27,600 for couples) in 2017 And your income and/or assets are above Full Extra Help Limits |
Partial Extra Help Premium depends on your income$82 deductible or the plan's standard deductible, whichever is cheaper. |
15% coinsurance or the plan copay, whichever is less After $4,950 in out of pocket drug costs, you pay $3.30/generic and $8.25/brand-name or 5% of the drug cost, whichever is greater. |
List of Opportunity Events
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ABC Medicare Help
4101 Perimeter Center Dr
Oklahoma City, OK 73112
405-701-3148 OKC
844-940-4357 Toll Free