The Medicare Extra Help program was created to assist beneficiaries with the costs associated with prescription drug coverage, including premiums, copays, and deductibles. If you’re eligible for a Medicare prescription drug plan and believe you may qualify for the Extra Help program, you can apply at any time throughout the year.
Automatic Qualification for Medicare Extra Help
You will automatically qualify for the Extra Help program if you meet any of the following criteria:
- You are eligible for both Medicare and Medicaid
- You participate in a Medicare Savings Program
- You receive Supplemental Security Income (SSI)
If you meet these requirements, you do not need to apply separately for the Extra Help program.
Income and Resource Eligibility Requirements
If you do not automatically qualify, you may still be eligible for Extra Help based on your income and resources.
Income Limits
To qualify, your income must generally be below:
- $18,735 per year for an individual
- $25,365 per year for a married couple
These amounts are set at 150% of the federal poverty level. However, if you are supporting other family members in your household, your income limits may be higher. Additionally, income requirements can vary by state.
Some types of income are excluded when determining your eligibility, such as:
- SNAP benefits (food stamps)
- Housing assistance
- Scholarships and education grants
- Payments for personal injury
- Disaster assistance
- Assistance for medical treatment and prescription drugs
Resource Limits
Your eligibility is also determined based on your resources, which include the items you own. Common countable resources include:
- Bank accounts (checking, savings, and money market accounts)
- Stocks, bonds, and ownership interests
- Individual Retirement Accounts (IRAs)
- Cash
- Real estate that is not your primary residence
Certain resources are excluded from eligibility calculations, such as:
- Your primary residence
- Personal property (e.g., furniture, clothing, appliances)
- Your automobile
- Money set aside for burial expenses
- Life insurance
The resource limits for the program are currently:
- $14,390 for an individual
- $28,720 for a married couple living together
If you’re unsure whether a particular resource will count toward your eligibility, contact your local Social Security office for clarification.
How to Apply for Medicare Extra Help
Applying for the Extra Help program is simple. Fill out the application form SSA-1020 and submit it to your local Social Security office. You can also complete the application online.
Need Help with Prescription Costs?
If you don’t qualify for the Medicare Extra Help program and are struggling to afford your prescriptions, contact us. We can help you explore other options to ensure you get the coverage and assistance you need.