Extra Help covers the costs Medicare Part D doesn't

Extra Help is a federal program that pays some or all of your prescription drug costs under Medicare Part D. It covers premiums, deductibles, and copayments — the out-of-pocket expenses that can add up quickly when you take multiple medications. The program is run by Social Security and the Centers for Medicare & Medicaid Services (CMS).

Whether you receive Extra Help depends on your income and resources. The income limits change each year, and they vary by household size and whether you live in the 50 states, Puerto Rico, or the U.S. Virgin Islands. If your income or resources are above the limit, you won't receive Extra Help, but you may still have other options to lower your drug costs.

Key Takeaways

  • Extra Help is available to people with Medicare Part D whose income falls below a certain level that changes yearly based on household size.
  • You must have both Medicare Part A or Part B and be enrolled in a Medicare Part D plan to receive Extra Help.
  • Social Security processes Extra Help requests, and you can submit one by phone, mail, or online through your Social Security account.
  • If you receive Supplemental Security Income (SSI) or certain other benefits, you may be automatically enrolled in Extra Help without having to request it.
  • Your Extra Help status is reviewed each year, and you will need to report any changes in income or household size.

Income and resource limits for Extra Help

Social Security sets income limits each year. For 2024, the monthly income limit for a single person is 150% of the federal poverty level, and for a married couple it is 200% of the federal poverty level. These percentages stay the same each year, but the dollar amounts rise with inflation. You can contact Social Security at 1-800-772-1213 to learn the exact limit for your household size in your state.

Extra Help also has a resource limit — the total value of money and property you own. For 2024, the resource limit is $8,100 for a single person and $12,150 for a married couple. Resources include bank accounts, stocks, and bonds, but not your home or car. If your resources exceed the limit, you will not receive Extra Help.

If your income or resources are close to the limit, it is worth contacting Social Security anyway. Some types of income are not counted, such as Supplemental Security Income (SSI) or certain veteran benefits. Social Security can tell you whether your specific situation qualifies.

Who is automatically enrolled in Extra Help

If you receive SSI or both Medicare and Medicaid, Social Security will enroll you in Extra Help automatically. You do not need to request it. Social Security will send you a notice telling you that you have been enrolled and which Part D plan you have been assigned to.

If you are automatically enrolled and want to choose a different Part D plan, you can switch during the annual enrollment period (October 15 through December 7 each year). You can also switch if you move to a different state or if your plan leaves the Medicare program.

How to request Extra Help if you are not automatically enrolled

You can request Extra Help through Social Security by phone, mail, or online. The fastest method is usually by phone: call 1-800-772-1213 (TTY 1-800-325-0778) Monday through Friday, 8 a.m. to 7 p.m. Eastern time. Have your Social Security number, birth date, and information about your income and resources ready.

You can also explore online through your Social Security account at ssa.gov. If you do not have an account, you can create one. The online form asks for your income, resources, and household information. Social Security will review your request and send you a notice within two to three weeks.

To explore by mail, request Form SSA-1020 from Social Security or read it from ssa.gov. Fill it out completely, sign it, and mail it to your local Social Security office. The address is on the form. Keep a copy for your records.

What happens after you request Extra Help

Social Security will review your income and resources and send you a written notice. If you are found to be within the income and resource limits, the notice will tell you the amount of help you will receive. It will also tell you which Part D plan you have been assigned to, or it will tell you that you can choose your own plan.

If you are not within the limits, the notice will explain why. You can ask Social Security to reconsider if you believe the decision is wrong. You have 60 days from the date of the notice to request reconsideration.

Once you are enrolled in Extra Help, your status is reviewed each year. If your income or household size changes, you should report it to Social Security. You can do this by phone, mail, or online. Reporting changes helps make sure you continue to receive the correct amount of help.

How much Extra Help covers

The amount of Extra Help you receive depends on your income. If your income is very low, Extra Help may cover all of your Part D costs, including premiums, deductibles, and copayments. If your income is higher but still within the limit, you will pay a small share of costs and Extra Help will cover the rest.

Social Security will tell you the exact amount in your notice. Your Part D plan will also send you information about your copayments and how much Extra Help covers. Keep this information with your insurance papers so you know what to expect when you fill a prescription.

What to do if your income or household changes

If your income increases or decreases, or if someone moves into or out of your household, you should report the change to Social Security. You have 30 days to report a change. If you do not report it, your Extra Help amount may be wrong, and you might owe money back.

You can report a change by calling Social Security at 1-800-772-1213, by logging into your Social Security account online, or by visiting your local Social Security office. Have your Social Security number and information about the change ready.

Frequently Asked Questions

Do I have to be on Medicare Part D to get Extra Help?

Yes. You must be enrolled in a Medicare Part D prescription drug plan to receive Extra Help. If you are not enrolled in Part D, you can join during the annual enrollment period (October 15 through December 7) or if you have a may have access to life event. Social Security can help you understand your options.

What if I am denied Extra Help?

You can ask Social Security to reconsider the decision within 60 days of receiving the notice. You can also contact your local Social Security office or call 1-800-772-1213 to discuss your situation. If your income or resources have changed since you applied, you can submit a new request.

Can I switch Part D plans if I have Extra Help?

Yes. You can switch plans during the annual enrollment period each year. If you are automatically assigned to a plan and want to choose a different one, you can do so during this time. You can also switch if you move to a different state or if your plan stops offering coverage in your area.

What counts as income for Extra Help?

Income includes wages, Social Security benefits, pensions, and interest from savings. Some types of income are not counted, such as SSI, certain veteran benefits, and some types of gifts. Social Security can tell you whether a specific type of income counts toward the limit.

Will Extra Help affect my other benefits?

No. Receiving Extra Help does not change your Social Security benefits, Medicare coverage, or other programs you receive. It is a separate program designed only to help with prescription drug costs.