If you meet certain income and resource limits, you may qualify for Extra Help from Medicare to pay the costs of Medicare prescription drug coverage.
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.)
Other people pay only a portion of their Medicare drug plan premiums and deductibles based on their income level.
In 2015, you may qualify if you have up to $17,655 in yearly income ($23,895 for a married couple) and up to $13,640 in resources ($27,250 for a married couple).
If you don't qualify for Extra Help, your state may have programs that can help pay your prescription drug costs. Contact your Medicaid office or your State Health Insurance Assistance Program (SHIP) for more information. Remember, you can reapply for Extra Help at any time if your income and resources change.
Countable resources include:
- Money in a checking or savings account
Countable resources don't include:
- Your home
- One car
- Burial plot
- Up to $1,500 for burial expenses if you have put that money aside
- Other household and personal items
Some people automatically qualify for Extra Help
You automatically qualify for Extra Help if you have Medicare and meet any of these conditions:
- Have full Medicaid coverage
- Get help from your state Medicaid program paying your Part B premiums (in a Medicare Savings Programs)
- Get Supplemental Security Income (SSI) benefits
Even if you automatically qualify this year, you may not qualify for Extra Help next year if changes in your income or resources cause you no longer to qualify for one of the programs listed above. You’ll get a notice (on grey paper) by the end of September if you no longer automatically qualify. Even if you get this notice, you may still qualify, but you need to apply to find out.
- If your copayment amounts change for 2016, you'll get a notice (on orange paper) in the mail in early October with the new amounts.
- If you don't get a notice from Medicare, you'll get the same level of Extra Help that you got for last year.
Paying the right amount
If 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. Get your plan's contact information from a Personalized Search (under General Search), or search by plan name.
Can I get money back if I've been paying too much?
If you aren't already enrolled in a Medicare drug plan and paid for prescriptions since you qualified for Extra Help, you may be able to get back part of what you paid. Keep your receipts, and call your plan. Or, you can contact Medicare's Limited Income Newly Eligible Transition (NET) Program at 1-800-783-1307 for more information. TTY users should call 711.
Other ways to lower your prescription drug costs
- Look into generic drugs. Ask your doctor if there are generics that will work as well as your current brand-name drugs.
- Ask your doctor about less expensive brand-name drugs.
- Consider using mail-order pharmacies.
- Use the Medicare Plan Finder to compare Medicare drug plans to find a plan with lower costs.
- Find out if your state offers help paying for drug costs.
- Find out if the company that makes your drug offers help paying for it.