Education for Justice FACT SHEET S-9 2009
MEDICARE PART D
EXTRA HELP PROGRAM
If you are paying too much
for your Medicare drug coverage, the Extra Help program may be able to pay for
your costs.
WHAT IS THE EXTRA HELP PROGRAM?
Extra Help is the name of a
Medicare program that can help you pay for the premiums, deductibles and
co-pays on your Medicare Part D drug plan.
You can get a full subsidy, which pays for most of
your costs. A partial subsidy will pay for some of your costs. These subsidies are based on your income and
resource levels. Your home, vehicles and
most personal property do not count in figuring out your resources. If you set aside $1,500 ($3,000 for a couple)
for funeral or burial expenses, that amount is not counted as resources either.
WHAT GETS COVERED WITH EXTRA HELP?
If you get a Full Subsidy
·
Extra Help pays
for premiums (your plan’s premiums must be lower than the “benchmark” premium)
·
you do not have a
deductible
·
your prescription
co-pays are $0 to $6.00
·
there is no coverage
gap.
If you get a Partial Subsidy
·
you pay only part
of the premium ($0 - $28)
·
you pay only a $60.00
deductible
·
your co-pay is
15% until your drug costs total up to $6,153.75, then your co-pay is between $2.40
to $6.00.
WHO CAN GET EXTRA HELP?
Some people automatically get
Extra Help. If you are on Medicare Part
D now and are in one of the following groups, you should already be signed up
for the Extra Help program:
·
Dual
Eligibles. This means that you get
Medicare Part A and/or Part B and you also get some form of help from Medicaid.
·
On a Medicare
Savings Program (QMB, SLMB, QI)
·
Getting SSI
If you are in 1 of these
groups and are NOT getting Extra Help, contact the Social Security
Administration and apply right away.
You can also get Extra Help
if you are on Medicare Part D now and meet the income eligibility rules.
WHAT ARE THE INCOME ELIGIBILITY
GUIDELINES?
The resource amounts below include the funeral and
burial expenses you can set aside. They
are $1,500 for one person, $3,000 for a couple.
For a Full Subsidy:
-
If you are single
you need to make under $14,621 a year and your resources cannot be worth more
than $8,100.
-
If you are a
married couple living together you need to make under $19,670 a year and your resources
cannot be worth more than $12,910 (you have to add both people’s income and resources
together).
For a Partial Subsidy:
-
If you are single
you need to make under $16,245 a year and your resources cannot be worth more
than $12,510.
-
If you are a
married couple living together you need to make under $21,855 a year and your resources
cannot be worth more than $25,010 (you have to add both people’s income and resources
together).
The income and resource
guidelines change every year. The ones
above are for 2009. The 2010 guidelines
are out early in 2010. The best place to
find the new guidelines is on the web at www.medicare.gov.
Or call 1(800) MEDICARE.
HOW DO I APPLY FOR EXTRA HELP?
You can apply for Extra Help
any time. You should apply through the
Social Security Administration or the State Medicaid office.
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