Extra Help is a program to help people with limited income and resources pay Medicare prescription drug program costs, like premiums, deductibles, and coinsurance. If you qualify for Extra Help, you won't pay a late enrollment penalty when you join a Medicare drug plan.
If you get Extra Help but you’re not sure if you're paying the right amount, call your drug plan. Your plan may ask you to give information to help them check the level of Extra Help you should get.
Examples of documents you can send your plan include:
- A purple notice from Medicare that says you automatically qualify for Extra Help.
- A yellow automatic enrollment notice from Medicare.
- An Extra Help "Notice of Award" from Social Security.
- An orange notice from Medicare that says your copayment amount will change next year.
- If you have , you can use your award letter from Social Security as confirmation that you have SSI.
You can also give your plan any of the documents listed below. Your plan must accept any of these documents as proof that you qualify for Extra Help. If you don't have or can't find any of these documents, ask your plan for help.
Proof you have Medicaid and live in an institution or get home- and community-based services
- A bill from an institution (like a nursing home). Or, a copy of a state document showing Medicaid paid for your stay for at least a month.
- A print-out from your state’s Medicaid system showing you lived in the institution for at least a month.
- A document from your state that shows you have Medicaid and are getting home- and community-based services.
Other proof you have Medicaid
- A copy of your Medicaid card (if you have one).
- A copy of a state document that shows you have Medicaid.
- A print-out from a state electronic enrollment file that shows you have Medicaid.
- A screen print from your state's Medicaid systems that shows you have Medicaid.
- Any other document from your state that shows you have Medicaid.
Once you give your plan this information, your plan must:
- Make sure you pay no more than the LIS drug coverage cost limit. In 2021, prescription costs are no more than $3.70 for each generic/$9.20 for each brand-name covered drug for those enrolled in the program. In 2022, these costs will be no more than $3.95 for each generic/$9.85 for each brand-name covered drug.
- Contact Medicare so we can get confirmation that you qualify, if it's available. Your request can take anywhere from several days to up to 2 weeks to process, depending on the circumstances. Call us at 1-800-MEDICARE (1-800-633-4227). TTY: 1-877-486-2048.
Be sure to tell your plan how many days of medication you have left. Your plan and Medicare will work to process your request before you run out of medication, if possible.