Medicare Part D & ‘Extra Help’ for prescription drugs
January 2017 | Danielle White, Esq.Our law firm was recently contacted by a client who was struggling with overwhelming prescription drug costs and looking for information on ways to alleviate the burden of those costs.
You may be in a similar situation on a fixed income, with limited resources and dependent upon expensive life-saving prescription medications. So what can you do if you find that the cost of your prescription medication is placing an undue burden on your finances?
Medicare prescription drug coverage is provided under Medicare Part D. Some individuals and couples may qualify for Extra Help for the cost of prescription drugs beyond what Part D covers through a federal program designed to help lower income families.
This Extra Help program is administered through the Social Security Administration (SSA), and you must apply and be approved by the SSA in order to receive the Extra Help.
In order to qualify for the Extra Help, your income and countable assets must be below the limits set each year. These limits change each year and you must re-apply each year in order to continue to receive the Extra Help.
The SSA will notify you when it’s time to renew your coverage, as coverage for this program terminates on December 31 of each year. If you do not submit the required documentation to renew your coverage, the coverage will terminate.
There are different levels of Extra Help available depending upon your particular income and asset levels, ranging from “full” Extra Help to “partial” Extra Help.
Most people who qualify for Extra Help do not pay for any prescription drug coverage premiums or deductibles, and their out of pocket expense is generally no more than $7.40 for each drug covered by their prescription plan.
Generally speaking, if you are single and your monthly income is between $1,010 and $1,505 and your countable assets are between $1,375 and $2,043, you will qualify for some level of Extra Help through the SSA for the costs of your prescription drug coverage.
The limits for married couples are $8,780 and $13,640 in monthly income and $13,930 and $27,250 in countable assets. These are the limits for 2016, which may go up for 2017.
Those numbers are not released until later this year, so if you believe that your income and/or assets may be too high for 2016, you may qualify for 2017. For those of you who are already on Medicaid, SSI and/or are currently enrolled in a Medicare Savings Program, you automatically qualify for Extra Help, although you still need to complete an application for the SSA.
If you are not already enrolled in a program that automatically qualifies you for Extra Help, you will need to file and submit an application along with proof of your income and countable assets.
Keep in mind that not all of your assets are counted toward this limit. Some specific assets are exempt from this calculation, including your home, one vehicle, a burial plot, up to $1,500 for burial expenses if you have put that money aside for that purpose, furniture, and other household and personal items.
Real estate outside of your primary residence; bank accounts, stocks, bonds and other investments; and mutual funds will count toward your asset calculation. In stark contrast to applying for Medicaid, IRAs and retirement accounts are also counted as assets when applying for Extra Help.
Many people probably qualify for Extra Help and may not even be aware that this program exists. However, if you do not qualify for Extra Help through this particular program, there are other options available to lower your prescription drug costs.
For instance, many states have their own programs known as State Pharmaceutical Assistance Programs (SPAP) and some pharmaceutical companies offer their own discounts through Patient Assistance Programs (PAPs).
Other options may include simply discussing the matter with your physician who can determine if there is a comparable drug available, if there is a generic equivalent available with a lower co-pay, or a discount available if you purchase more pills at a time.
Depending on what medications you are taking, your physician may be able to offer you free samples if he or she has them in the office. In addition, you may contact your county public health department to see if they have a free medicine program.
You are also encouraged to complete an “Application for Extra Help with Medicare Prescription Drug Plan Costs” (SSA-1020) form with the Social Security Administration. You can apply and submit this form by:
1. Applying online at www.socialsecurity.gov/extrahelp
2. Calling the Social Security Administration at 800-771-1213 (TTY 800-325-0778) and requesting that an application be mailed to you or applying over the phone
3. Applying in person at your local Social Security office
And you can always contact your Legal Service Plan attorneys for information about this or any other topic.
You may be in a similar situation on a fixed income, with limited resources and dependent upon expensive life-saving prescription medications. So what can you do if you find that the cost of your prescription medication is placing an undue burden on your finances?
Medicare prescription drug coverage is provided under Medicare Part D. Some individuals and couples may qualify for Extra Help for the cost of prescription drugs beyond what Part D covers through a federal program designed to help lower income families.
This Extra Help program is administered through the Social Security Administration (SSA), and you must apply and be approved by the SSA in order to receive the Extra Help.
In order to qualify for the Extra Help, your income and countable assets must be below the limits set each year. These limits change each year and you must re-apply each year in order to continue to receive the Extra Help.
The SSA will notify you when it’s time to renew your coverage, as coverage for this program terminates on December 31 of each year. If you do not submit the required documentation to renew your coverage, the coverage will terminate.
There are different levels of Extra Help available depending upon your particular income and asset levels, ranging from “full” Extra Help to “partial” Extra Help.
Most people who qualify for Extra Help do not pay for any prescription drug coverage premiums or deductibles, and their out of pocket expense is generally no more than $7.40 for each drug covered by their prescription plan.
Generally speaking, if you are single and your monthly income is between $1,010 and $1,505 and your countable assets are between $1,375 and $2,043, you will qualify for some level of Extra Help through the SSA for the costs of your prescription drug coverage.
The limits for married couples are $8,780 and $13,640 in monthly income and $13,930 and $27,250 in countable assets. These are the limits for 2016, which may go up for 2017.
Those numbers are not released until later this year, so if you believe that your income and/or assets may be too high for 2016, you may qualify for 2017. For those of you who are already on Medicaid, SSI and/or are currently enrolled in a Medicare Savings Program, you automatically qualify for Extra Help, although you still need to complete an application for the SSA.
If you are not already enrolled in a program that automatically qualifies you for Extra Help, you will need to file and submit an application along with proof of your income and countable assets.
Keep in mind that not all of your assets are counted toward this limit. Some specific assets are exempt from this calculation, including your home, one vehicle, a burial plot, up to $1,500 for burial expenses if you have put that money aside for that purpose, furniture, and other household and personal items.
Real estate outside of your primary residence; bank accounts, stocks, bonds and other investments; and mutual funds will count toward your asset calculation. In stark contrast to applying for Medicaid, IRAs and retirement accounts are also counted as assets when applying for Extra Help.
Many people probably qualify for Extra Help and may not even be aware that this program exists. However, if you do not qualify for Extra Help through this particular program, there are other options available to lower your prescription drug costs.
For instance, many states have their own programs known as State Pharmaceutical Assistance Programs (SPAP) and some pharmaceutical companies offer their own discounts through Patient Assistance Programs (PAPs).
Other options may include simply discussing the matter with your physician who can determine if there is a comparable drug available, if there is a generic equivalent available with a lower co-pay, or a discount available if you purchase more pills at a time.
Depending on what medications you are taking, your physician may be able to offer you free samples if he or she has them in the office. In addition, you may contact your county public health department to see if they have a free medicine program.
You are also encouraged to complete an “Application for Extra Help with Medicare Prescription Drug Plan Costs” (SSA-1020) form with the Social Security Administration. You can apply and submit this form by:
1. Applying online at www.socialsecurity.gov/extrahelp
2. Calling the Social Security Administration at 800-771-1213 (TTY 800-325-0778) and requesting that an application be mailed to you or applying over the phone
3. Applying in person at your local Social Security office
And you can always contact your Legal Service Plan attorneys for information about this or any other topic.