Medicare Low Income Subsidy

Low-Income Subsidy for Medicare Drug Coverage

People who have Medicare Part D with low income and need to pay for their prescription drug costs can get something called “Extra Help”. Worth about $4,000 per year, it covers:

• Part D monthly premiums
• Annual deductibles
• Coinsurance
• Medication copayments

People with Extra Help also won’t have a gap in drug coverage, or “donut hole” in their Medicare plan. A donut hole is when your plan has reached the limit on drugs that will be paid for. In 2018, when you’ve reached $3,750 in drug costs, you’ve reached the coverage gap. This amount changes every year.

To apply for Extra Help you may qualify if you have up to $18,210 in yearly income ($24,690 for a married couple) and up to $14,100 in resources ($28,150 for a married couple). Resources are things like:

• Money in a checking or savings account
• Certificates of deposit
• Stocks and bonds
• Mutual funds and IRAs
• A second home (or more)
• A second car (or more)

How to Apply

1. Go to the SSA website at socialsecurity.gov/extrahelp. The application is secure, so only you and the Social Security Administration will see the information you give.
2. Visit the Social Security Administration office and apply in person.
3. You can also get an application form by calling Social Security's toll-free number: 1-800-772-1213, Monday – Friday, 7 a.m. to 7 p.m. (TTY: 1-800-325-0778). You can ask for a form or apply over the phone.

What if I don’t qualify for Extra Help?

What if I don’t qualify for Medicare Savings Programs or Extra Help?

There are other programs besides Extra Help to give you the aid to pay for your drugs. Some states have State Pharmaceutical Assistance Programs (SPAPs) and also Patient Assistance Programs (PAPs) where drug manufacturers give discounts on their brand name drugs.

If you’re denied Extra Help, Social Security will automatically send your information to the State Health Insurance Assistance Program. Someone will reach out to you to figure out if you’re eligible for one of the Medicare Savings Program.