What is the Medicare Extra Help Program?

You might be eligible for assistance to cover some of the costs of your health care and prescription coverage if you have a low income and few resources. The Medicare Extra Help Program provides that assistance for you.
What is the Medicare Extra Help Program?

You might be eligible for assistance to cover some of the costs of your health care and prescription coverage if you have a low income and few resources.Help with Part DThe Extra Help program aids those with low income and resources in covering the cost of their Medicare prescriptions. If your annual income and resources fall within the following ranges in 2023, you might be eligible for Extra Help:| | Yearly income | Other resources || --- | --- | --- || Single person | less than $20,385 | less than $15,510 || Person living with a spouse and no other dependants | less than $27,465 | less than $30,950 | Even if you make a higher salary, live in Alaska or Hawaii, or have dependents living with you, you can still be eligible. A bank or savings account, securities like bonds and equities, mutual funds, and individual retirement accounts are examples of resources. Your house, car, furniture, burial plot, up to $1,500 in burial costs (per person), and life insurance policies are not considered resources.If you are eligible for Extra Help and sign up for a separate Medicare drug plan or a Medicare Advantage plan that includes Part D coverage for prescription drugs:* You'll get assistance with your prescription coverage expenses.* You won't be charged a late enrollment fee.If you have Medicare and satisfy any of the following requirements, you are immediately eligible for Extra Help:* You are fully covered by Medicaid.* Your state Medicaid program assists you in paying your Part B premiums (in a Medicare Savings Program).* You are eligible for Supplemental Security Income (SSI).Medicare will send you a purple letter informing you that you are automatically eligible for Extra Help. Keep a copy for your records. If you receive this letter, you do not need to apply for Extra Help.Prescription expenses for persons who qualify in 2023 are expected to be no more than $4.15 for each generic drug and $10.35 for each brand-name drug. Check your Extra Help letters or contact your plan to find out your specific expenses.## What If You Need Help Paying For Medicare Health Care Costs?If you have limited income and resources, your state may be able to assist you to pay your Medicare payments if you satisfy specific criteria.States expressly have programs that pay Medicare premiums and, in certain situations, may also cover Medicare Part A (inpatient hospital insurance) and Medicare Part B (outpatient medical insurance) deductibles and coinsurance for those with low incomes and financial resources. ## 4 kinds of Medicare Savings Programs* **Qualified Medicare Beneficiary (QMB) Program:** Helps pay for Part A and/or Part B premiums, deductibles, coinsurance, and copayments.* **Specified Low-Income Medicare Beneficiary (SLMB) Program:** Helps pay Part B premiums only.* **Qualifying Individual (QI) Program:** Solely aids in paying Part B premiums. For QI benefits, you must apply each year, and applications are approved on a first-come, first-served basis.* **Qualified Disabled and Working Individuals (QDWI) Program:** Solely aids in paying Part A premiums. If you have a handicap and are employed, you could be eligible for this program.Many times, in order to be eligible for a Medicare Savings Program, your income and resources must be below a certain threshold, as explained below. Each year, these limits are raised.Even if your income or resources are greater than the maximum amount allowed, you can still be eligible for these programs. When determining who qualifies, certain states don't take into account certain sorts of income or resource amounts.## Qualified Medicare Beneficiary (QMB) Program**Helps pay for:** Part A premiums, Part B premiums, deductibles, coinsurance, and copayments*Average numbers for 2022 (Limits slightly higher in Alaska and Hawaii)*| Your Situation | Monthly Income Limit | Resource Limit || --- | --- | --- || Individual | $1,153 | $8,400 || Married couple | $1,546 | $12,600 | If you meet the requirements for the QMB program:* Medicare providers are not permitted to charge you for the services and products that Medicare covers, including deductibles, coinsurance, and copayments.* If a Medicaid copayment applies, you may receive a bill for it.* Additionally, you'll receive Extra Assistance in paying for your prescription medications. In 2022, the maximum cost of medicine covered by your Medicare prescription plan will be $4.## Specified Low-Income Medicare Beneficiary (SLMB) Program**Helps pay for:** Part B premiums (You must have Part A and Part B to qualify)*Average numbers for 2022 (Limits slightly higher in Alaska and Hawaii)*| Your Situation | Monthly Income Limit | Resource Limit || --- | --- | --- || Individual | $1,379 | $8,400 || Married Couple | $1,851 | $12,600 | If you meet the requirements for the SLMB program:* You'll also receive Extra Assistance to help you pay for your prescription medications.* In 2022, the maximum cost of medicine covered by your Medicare prescription plan will be $9.85## Qualifying Individual (QI) Program**Helps pay for:** Part B premiums (You must have Part A and Part B to qualify)*Average numbers for 2022 (Limits slightly higher in Alaska and Hawaii)*| Your Situation | Monthly Income Limit | Resource Limit || --- | --- | --- || Individual | $1,549 | $8,400 || Married couple | $2,080 | $12,600 | If you meet the requirements for the QI program:* To continue in the QI Program, you must reapply each year.* States operate on a first-come, first-served basis for approving applications. People who received QI benefits the previous year are given priority.* You'll also receive Extra Aid to help you pay for your prescription medications. For any medicine your Medicare prescription plan covers in 2022, you won't have to spend more than $9.85.You cannot get assistance from the QI program if you are eligible for Medicaid, but you might be able to receive assistance through another Medicare Savings Program.## Qualified Disabled Working Individual (QDWI) Program**Helps pay for:** Part A premiums (You must have Part A and Part B to qualify)*Average numbers for 2022 (Limits slightly higher in Alaska and Hawaii)*| Your Situation | Monthly Income Limit | Resource Limit || --- | --- | --- || Individual | $4,615 | $4,000 || Married couple | $6,189 | $6,000 | If you meet the requirements for the QI program:* Have a disability* Are working* Lost Your Social Security disability benefits and Medicare premium-free Part A because you returned to workThe only program that can assist a working disabled person is the QDWI program. Your Part A premiums are paid for by QDWI, but it doesn't cover the Part A deductible, copayments, or anything else related to Part B. If, despite working, your income is extremely low (under 135% FPL), you may be eligible for a Medicare Savings Program that covers part of these costs.