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Do You Know People Who May Be Eligible for Part D’s Extra Help?

California Health Advocates > Low Income Help > Do You Know People Who May Be Eligible for Part D’s Extra Help?

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Karen Fletcher

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Do you know people who are struggling to pay their Medicare Part D prescription drug costs? If so, they may qualify for help through Medicare’s Part D low-income subsidy (LIS), also known as Extra Help. For those who qualify, the Extra Help can save them thousands of dollars a year by helping cover the cost of their Part D plan premium, deductible and drug copayments. Despite how good these benefits are, many people who qualify are unaware of this program. Please help us reach those not yet enrolled by passing on the word on the Extra Help program and encouraging people to apply. (Note: the Medicare Savings Programs (MSPs) can also help cover some of Medicare’s costs for those who qualify, and save beneficiaries thousands of dollars a year.)

Below are 5 good enticing facts to know about Medicare Part D’s Extra Help, taken from the National Center on Law and Elder Rights.

  1. People with Medicare can enroll in the Part D low-income subsidy (LIS), or Extra Help, at any time in the year. Applications can be completed online at the Social Security website1 or in person at any Social Security office. Enrollment usually does not require producing documents like bank statements or insurance policies.
  2. Extra Help coverage lasts until the end of the year, even for those who no longer qualify for Medicaid. This can be particularly helpful for older adults with a Medicaid share of cost. If they meet their share of cost even once, they qualify for Extra Help for the rest of the year. If they meet it in July or later, they qualify for Extra Help for the rest of that year and all of the next year.
  3. People with Extra Help can change Part D plans and Medicare Advantage Part D (MA-PD) plans at any time without a penalty.They do not have to wait for an open enrollment period. This can be helpful for clients who have recently been diagnosed with a chronic condition or who have changed prescriptions and find that the formulary of their current plan does not meet their needs.
  4. Extra Help is not subject to estate recovery. Many seniors are fearful of applying for Medicaid because estate recovery laws may allow states to recoup some costs from their estates. Extra Help is different. There is no estate recovery for Extra Help costs. Federal law does not permit states or the federal government to collect money from your client’s estate for Extra Help costs. Medicare Savings Programs (QMB, SLMB and QI) also are exempt from estate recovery.
  5. People with full Extra Help qualify for a $10 a month Social Security overpayment plan. It is not uncommon for clients to owe Social Security for an overpayment of benefits. When this happens, clients often find that a large portion of their Social Security benefit is being deducted to pay back the debt. If your client has Extra Help, however, the client can request that Social Security take out only $10 a month. Social Security is required to automatically honor the request when it is made.

Karen Joy Fletcher

Our blogger Karen Joy Fletcher is CHA’s Communications Director. With a Masters in Public Health from UC Berkeley, she is the online “public face” of the organization, provides technical expertise, writing and research on Medicare and other health care issues. She is responsible for digital content creation, management of CHA’s editorial calendar, and managing all aspects of CHA’s social media presence. She loves being a “communicator” and enjoys networking and collaborating with the passionate people and agencies in the health advocacy field. See her current articles.

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Do you have comments or concerns about your Medicare coverage? Issues regarding getting your needed prescriptions from your Part D plan, or a Medicare Advantage plan representative’s marketing practices? Let us know at comments@cahealthadvocates.org.

We are dedicated to making Medicare’s program work well for all beneficiaries. Your feedback from your own or your client’s concerns and experiences with Medicare, will guide our Medicare advocacy efforts with key policy and decision-makers in both California and nationally with the Centers for Medicare and Medicaid Services (CMS) and Congress.

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