2025 Medicare Drug Expenses with Extra Help Program Apply Online: Individuals who do not possess Medicaid, Supplemental Security Income (SSI), or a Medicare Savings Program (MSP) have the option to apply for the Medicare Drug Expenses with Extra Help Program through the Social Security Administration (SSA) by utilizing either the printed or online application forms provided by the agency. Those who are beneficiaries of Medicaid, SSI, or an MSP are typically enrolled in Medicare Drug Expenses with Extra Help Program automatically.
For Medicare Drug Expenses with Extra Help Program online applications, one can access the SSA’s website at www.ssa.gov. Depending on the specific procedures in your state, this application may also function as a screening tool for eligibility for a Medicare Savings Program, which assists in covering Medicare-related expenses. It is essential to complete the application thoroughly and provide precise information to ensure that you receive all applicable benefits.
Medicare Drug Expenses with Extra Help Program 2025
Medicare Part D offers prescription drug coverage, and the Extra Help program is designed to alleviate the financial burden associated with prescription medications, including deductibles and copayments. Applications for Extra Help can be submitted at any time, whether prior to or following enrollment in Part D. If you are a Medicare beneficiary with limited income and assets, you may be eligible for “Extra Help” with your prescription drug costs.
This Medicare Drug Expenses with Extra Help Program is also referred to as the Part D Low Income Subsidy (LIS), and it is administered collaboratively by the Social Security Administration (SSA) and the Centers for Medicare & Medicaid Services (CMS) to provide this vital assistance.
Medicare Extra Help Advantages
- The advantages of the Low-Income Subsidy (LIS) or Extra Help program are significant.
- In 2024, the criteria for receiving the full Extra Help benefit were broadened to include individuals with incomes up to 150% of the Federal Poverty Level (FPL), while the partial subsidy option was removed.
- By 2025, the majority of individuals eligible for Extra Help will incur no premiums for their prescription drug plans, will not face any deductibles, and will pay a maximum of $12.15 for each covered brand-name medication and $4.90 for generic drugs.
- It is important to note that individuals who also possess full Medicaid coverage and are participants in the Qualified Medicare Beneficiary (QMB) Medicare Savings Program will only be required to pay a maximum of $4.80 for each covered prescription.
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Medicare Extra Help (LIS)
Extra Help not only reduces out-of-pocket expenses but also provides several important protections. Beneficiaries have the opportunity to enroll in or change their Medicare Part D drug plans during a Special Enrollment Period, which occurs every three months from January to September, in addition to once during the annual Open Enrollment Period. This flexibility allows individuals to modify their plans without waiting for the traditional Open Enrollment window, which runs from October 15 to December 7.
Any adjustments made outside of this period will take effect the following month, which is particularly advantageous for those who need to initiate medications that are not included in their current plan’s formulary. Furthermore, there is no late enrollment penalty for Part D, even if individuals choose to enroll after their initial eligibility period and lack alternative drug coverage.
Limited Income Newly Eligible Transition (LINET) program
The Limited Income Newly Eligible Transition (LINET) program serves to deliver prompt yet provisional Part D prescription drug coverage to low-income individuals enrolled in Medicare who are eligible for the Low-Income Subsidy (LIS) or Extra Help but lack any existing prescription drug coverage.
This assistance is accessible for duration of up to two months, providing a crucial safety net until the individual can enroll in a Medicare drug plan. Individuals who qualify as “dual eligible,” meaning they receive both Medicare and Medicaid benefits, are automatically enrolled in the LINET program.
For those who do not meet the criteria for dual eligibility but believe they may qualify for LINET, it is advisable to consult with their pharmacist for guidance.
What does Social Security Extra Help pay for?
How can someone reduce their Medicare prescription drug expenses with the Extra Help program?
The Inflation Reduction Act has broadened the scope of the Extra Help program, allowing more individuals with Medicare to access greater savings on their prescription medications. This program assists in covering various costs associated with Medicare drug coverage (Part D), including premiums, deductibles, and other out-of-pocket expenses.
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What are the specific benefits of Extra Help in 2024?
- For those who qualify, the benefits include no premium payments for your Medicare drug plan, no deductible costs, and significantly reduced prices for medications—up to $4.50 for generic drugs and up to $11.20 for brand-name drugs.
- To take advantage of Extra Help, you must have Medicare drug coverage. Once you qualify, Medicare will notify you with a list of plans that offer $0 premiums and deductibles.
- If you do not select a plan, Medicare will automatically enroll you in one that meets these criteria.
- While you have the option to choose a different drug plan, be aware that it may come with higher costs if it does not provide the same $0 premium and deductible benefits for those eligible for Extra Help.
Who qualifies for Extra Help Medicare
Generally, you need to reside in one of the 50 states or the District of Columbia and have income and resources that fall below specific thresholds:
• For 2024, your annual income should be less than $22,590 for an individual or $30,660 for a married couple.
• Your resources must not exceed $17,220 for an individual or $34,360 for a married couple in 2024.
SSA Extra Help Key Points
Resources encompass funds in checking, savings, or retirement accounts, as well as stocks and bonds. However, they do not include your primary residence, one vehicle, burial plots, up to $1,500 set aside for burial costs, furniture, and other personal or household items.
These limits may be adjusted annually. If you currently receive Extra Help and continue to meet the eligibility criteria next year, you will automatically receive these savings without needing to reapply. Even if you do not qualify for Extra Help at the moment, you can submit a new application anytime your income or resources change.
