Medicare Part D Low Income Subsidy – Extra Help

The May 6 issue of JAMA Internal Medicine reported on a research finding that of  low-income Medicare beneficiaries  eligible for extra help that only 58% were aware of the subsidy and only 25.5% had applied for it. The study included only people likely eligible for the subsidy, who were not automatically enrolled for it.

The Part D Low Income Subsidy is referred to as “Extra Help” on the Social Security and CMS Web sites. It helps low-income Medicare beneficiaries pay the for the premium of a Part D plan, as well as co-pays and deductibles. It is worth about $4,000 per year to a person eligible for the full subsidy. And many people are eligible for a partial subsidy if their income level is too high for a full subsidy.

In order to qualify for Extra Help  in 2013 a Medicare beneficiary :

  • Must reside in one of the 50 states or the District of Columbia. U.S. Territories have similar programs run by territorial governments;
  • Must have resources limited to $13,300 for an individual or $26,580 for a couple. This includes bank accounts and investments, but does not include a home, car, or life insurance;
  • Must have annual income limited to $17,235 for an individual or $23,265 for a couple. Those with higher incomes may be eligible if they support other family members in the same household, have earnings from work, or live in Alaska or Hawaii.

People who are fully eligible for Medicaid as well as Medicare, who are in a Medicare savings program, and who receive SSI are automatically deemed eligible for Extra Help, and should receive the subsidy without filing an application, based on information reported to the Social Security Administration by their state Medicaid agency.

If you believe you or a someone you care for may be eligible for the low-income subsidy for a Medicare Part D plan, you can apply at the Social Security Website, by calling Social Security at 1-800-772-1213, or by going to your local Social Security office.

In response to the application, Social Security will notify you by mail whether you qualify. Once you qualify, you can select a Medicare Part D plan drug plan and/or a Medicare Advantage Plan. When you are newly qualified for the low-income subsidy you will have a special enrollment period for Medicare Part D and Medicare Advantage , so you do not have to wait for the open enrollment period, and you will not have to pay a late enrollment penalty. If you already have a Part D plan for which you have been paying, the plan sponsor will be notified, the subsidy will be retroactive to the date you applied, and you will be reimbursed by any premiums or co-pays you paid since application.

A Medicare Pathways benefit advisor can help you navigate the system and find a Part D or Medicare Advantage plan. T speak with a Medicare Pathways benefit advisor call 1-866-466-9118 or click here for a quote.