To check the level of Extra Help you're entitled to, you'll need to provide some information.
Examples of documents you can send your plan include:
- A purple notice from Medicare that says you automatically qualify for Extra Help.
- A yellow or green 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 Supplemental Security Income (SSI), you can use your award letter from Social Security as proof that you have SSI.
You can also give your plan any of the following documents (called "Best Available Evidence"), which they must accept 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 the 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 that you lived in an institution for at least a month and that Medicaid paid for your stay.
- 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 or 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 2015, drug costs for most people who qualify are no more than $2.65 for each generic/$6.60 for each brand-name covered drug. (In 2016, costs are no more than $2.95 for each generic/$7.40 for each brand-name covered drug.)
- Contact Medicare so we can get proof that you qualify, if it's available. You can expect your request to take anywhere from several days to up to 2 weeks to process, depending on the circumstances. Call 1-800-MEDICARE (1-800-633-4227).
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.