Extra Help is a federal program that helps pay for some to most of the out-of-pocket costs of Medicare prescription drug coverage. It is also known as the Part D Low-Income Subsidy (LIS).
If you are enrolled in Medicaid, you automatically qualify for Extra Help regardless of whether you meet Extra Help’s eligibility requirements. You should receive a purple-colored notice from the Centers for Medicare and Medicaid Services (CMS) informing you that you do not need to apply for Extra Help.
The Extra Help program:
- Pays for your Part D premium up to a state-specific benchmark amount.
- Lowers the cost of your prescription drugs
- Gives you a Special Enrollment Period (SEP) once per calendar quarter during the first nine months of the year to enroll in a Part D plan or to switch between plans (You cannot use the Extra Help SEP during the fourth calendar quarter of the year (October through December). You should use Fall Open Enrollment during this time to make prescription drug coverage changes.); and
- Eliminates any Part D late enrollment penalty you may have incurred if you delayed Part D enrollment.
To receive Extra Help assistance, your prescriptions should be on your plan’s formulary and you should use pharmacies in your plan’s network.
Remember that Extra Help is not a replacement for Part D or a plan on its own. You must still have Part D to receive Medicare prescription drug coverage and Extra Help assistance. If you do not choose a plan, you will in most cases be automatically enrolled in one.
Extra Help Eligibility
- If your monthly income and assets are within specified limits, you may be eligible for Extra Help. Even if your income or assets are above the eligibility limits, you could still qualify for Extra Help because certain types of income and assets may not be counted.
- If you are enrolled in Medicaid, Supplemental Security Income (SSI), or a Medicare Savings Program, you automatically qualify for Extra Help regardless of whether you meet Extra Help’s eligibility requirements. You should receive a purple-colored notice from the Centers for Medicare & Medicaid Services (CMS) informing you that you do not need to apply for Extra Help.
Read Next: Does Part B Have a Late Enrollment Penalty?
Learn About: What Can I do to Appeal for a Part B Late Enrollment Penalty?
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