Maintaining your quality of life can become more challenging as you age. In addition to routine living expenses, your medical bills may begin to pile up, consuming more and more of your limited income.
This can be worrisome for Medicare beneficiaries, who remain the only insured population without a cap on out-of-pocket spending. Older adults are more likely to require medications for multiple conditions, which means multiple co-pays. And these extra bills can create a significant burden. The good news is that you may qualify for Medicare’s Extra Help program, which could help lower your medication costs by 85% or more.
What is the Extra Help program?
Run by the Social Security Administration, the Extra Help program — also known as the Low-Income Subsidy program — helps qualified Medicare beneficiaries afford the costs related to their prescription drugs, including premiums, deductibles and co-pays.
There is a full and a partial coverage version of the plan available, depending on your income level and assets, but both versions have huge potential for savings. For example, if a medication would normally cost $12,000 a year out of pocket, through the Extra Help partial program, your payment could be reduced to about $1,900. With full Extra Help, you would pay $0.
Most people who qualify for the full program are automatically enrolled, because they are already enrolled in Medicaid and Medicare, or another support program. But many people are eligible for the partial program and don’t realize it, missing out on big savings. An individual might be eligible for the program if they have an annual income under $20,000 and less than $15,000 in assets, but there are some exceptions, and the limits are higher for couples. Want to check your eligibility? Start with this free, interactive quiz.
How does this program cover the costs?
The Extra Help program can help save money, but there is a lot more to it than that. Here are a few other benefits it can provide:
It pays for Part-D premiums: Most Medicare recipients have to pay a monthly fee as part of their premium. These premiums can be expensive depending on the prescription. Fortunately, the Extra Help program pays a portion of this premium. However, how much the program pays for can vary, as different states have different amounts they’re willing to set aside.
It gives qualified patients a special enrollment period: Most Medicare recipients can only enroll in prescription drug coverage during open enrollment between Oct. 15 and Dec. 7. But with the Extra Help program, participants have a Special Open Enrollment period that runs through the first nine months of the year.
It eliminates late enrollment penalties: If you’ve enrolled late for Part-D Medicare benefits before, you’ve probably paid a penalty fee. The fee is 1% of the national base beneficiary premium, which was $32.74 in 2020. But for those who are part of the Extra Help program, these fees usually get eliminated.
There is a path to affordable treatment
With all the valuable benefits the Extra Help program can provide, qualifying requires getting your financial documents in order and filling out an application. This can seem overwhelming at first, but the PAN Foundation’s education hub can help. It includes videos that explain the process, an eligibility checker and an interactive check list to get you ready to apply. And if you get approved, the benefits can help you save a lot of money over the years.