Many people do not know about a program called ‘Extra Help’. Or they may have heard of it and think it is the same as Medicaid. So, what is it and could you qualify? Extra Help is federal assistance for Medicare Beneficiaries aimed at prescription drugs only. If you qualify, it helps with drug plan premiums, drug deductibles, and copays. Surprising to many, the cost of prescription drugs is in most cases, the biggest expense to a Medicare Beneficiary. We recently had a client come to the office so excited and ready to sign up for Medicare thinking it was going to be such cost savings over his employer plan. He was right in that the out-of-pocket costs for medical visits and procedures were much lower. However, when he found out how much his prescription drugs were going to cost on Medicare versus the Employer Plan, it was a different story. We advised him to stay on the Employer Plan for now if he planned to continue working. So do not underestimate the importance of the drug plan costs in considering your Medicare options.
Extra Help is NOT Medicaid
While meeting with another client recently, we looked at the high cost of her medications and suggested she apply for Extra Help. Her response was something like this, ‘We already applied for Medicaid and were denied.’ So let us explain. Extra Help is different, and the qualifiers are different. So do not count it out. To qualify, two main factors are considered: resource limits and income limits. However, unlike Medicaid, your house, farm, vehicles, and life insurance policies are not factored in. Even rental property is not counted against you if it is paying your monthly bills. Let’s elaborate……
Resource Limits
In looking at resource limits, Extra Help only considers liquid assets such as savings accounts, stocks, bonds, mutual funds, and IRAs. Those assets can be easily turned into cash. In 2021, the resource limit is $14,790 for an individual and $29,520 for a married couple living together. Resources will be reviewed in addition to income.
Income Limits
As for income limits, in 2021, those are $19,320 for an individual and $26,130 for a married couple. But wait – you still may qualify even if your income is higher, but you have adult dependents living in your home! This is a common phenomenon currently with so many adults out of work or in between jobs. At this point, an appeal may have to be considered. What we have found is that SSA will look at income alone even though the application may include information about dependents living in the home and deny the Extra Help. We still would not stop there. At this point, it is worth a call to SSA and proceed with an appeal. We encountered this recently with yet another client. We guided her completely through the appeal. She got an appointment with an SSA representative over the phone which helped in that she could discuss her entire living situation. And guess what, her Extra Help was approved!
How and Where to Apply
The cool thing is that it is very easy to apply and costs nothing. Simply applying for Extra Help has no bearing on your plan availability, choices, or costs. You can apply and be denied with no adverse consequences. You can also apply any time of year. If you do qualify, you then get a Special Enrollment Period to change plans that are better designed to work with the Extra Help. So how do you apply? Online, of course! You will need to have your resource and income information handy whether it be bank statements, earning statements and/or IRA balances. You can apply here: https://www.ssa.gov/benefits/medicare/prescriptionhelp.html
As always, if you would like assistance from someone who has guided many through the online application and appeal process, reach out to us! Our guidance and assistance cost you nothing. For more information, email me at carrie@cdi-cares.com or check me out at www.cdi-cares.com
n “Educating the mind without educating the heart is no education at all.”
o Aristotle