Help with drug costs
What's Extra Help?
"Extra Help" is a Medicare program to help people with limited income and resources pay Medicare drug coverage (Part D) premiums, deductibles, coinsurance, and other costs. What’s a premium, deductible, coinsurance, or copayment?
You also won't have to pay a Part D late enrollment penalty while you get Extra Help. What's the Part D penalty?
Some people qualify for Extra Help automatically, and other people have to apply.
Who gets Extra Help automatically?
You'll get Extra Help automatically if you get:
- Full Medicaid coverage
- Help from your state paying your Part B premiums (from a Medicare Savings Program )
- Supplemental Security Income (SSI) benefits from Social Security
You'll get a letter about your Extra Help. It tells you things like how much you'll pay, and your new Medicare drug plan, if you don't have one already.
If you don’t automatically get Extra Help, you can apply for it:
Or call Social Security at 1-800-772-1213. TTY users can call 1-800-325-0778.
Who should apply for Extra Help?
In most cases, to qualify for Extra Help, you must have income and resources below a certain limit. These limits go up each year.
The income limit is based on your income from the previous year.
Income and resource limits in 2022:
|Your situation:||Income limit:||Resource limit:
What counts in resource limits?
If you qualify for Extra Help
We’ll automatically enroll you in a Medicare drug plan (Part D) , if you don’t have one already. We do this so you can get the cost savings you qualify for.
- You’ll get a letter telling you:
- About your new plan. You can pick a different Medicare drug plan if you want.
- What you’ll pay, depending on the “level” of Extra Help you get.
- That you get Extra Help for the rest of the calendar year. Even if your income changes in the middle of the year, you’ll keep getting Extra Help through December 31.
- If you meet the income and resource limits for next year, you’ll keep getting Extra Help. We’ll mail you a letter only if:
- Your Extra Help changes.
- You no longer qualify for Extra Help.
- You get moved to a different plan for next year.
- If you don’t get a letter from Medicare or Social Security, you’ll keep the same level of Extra Help and same plan for next year.
|Extra Help Level:||In 2022, you'll pay:|
|Full Extra Help||
Plan premium: $0
Plan deductible: $0
Once your total drug costs (what both you and your plan pay) reach $7,050 ($7,400 in 2023), you’ll pay $0 for each covered drug.
|Partial Extra Help||
Plan premium: Varies based on your income. Plan premiums if you have Partial Extra Help
Plan deductible: No more than $99 ($104 in 2023)
Prescriptions: No more than 15% of the cost for each covered drug
Once the total drug costs (what both you and your plan pay) reach $7,050 ($7,400 in 2023), you’ll pay no more than:
Do you think you're paying the wrong amount for your prescription(s)?
If you qualify for Extra Help and think you’re paying the wrong amount, here’s what you can do:
- Contact your drug plan. Your plan may ask for proof that you get Extra Help so they can correct your costs. Examples of proof you get Extra Help .
- Call us at 1-800-MEDICARE (1-800-633-4227). TTY users can call 1-877-486-2048. We can tell you your level of Extra Help and help you get your costs fixed with the plan.
You may be able to get some money back if you:
- Paid for prescriptions after you qualified for Extra Help
- Aren’t in a Medicare drug plan
Keep your receipts with your prescription drug prices, and call Medicare's
Limited Income Newly Eligible Transition (NET) Program
1-800-783-1307. TTY users can call 711.
Other ways to lower your prescription drug costs:
- Join Medicare drug coverage (Part D):
- Compare Medicare drug plans to find a plan with lower drug costs.
- Check if the company that makes your drug offers help paying for it.
- Find out if your state offers help with drug costs.
- Ask your doctor if you can take a generic drug, or a cheaper brand-name drug (if one’s available).
- Check costs for mail-order pharmacies. Sometimes using a mail order pharmacy is cheaper.