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Can I Get Help with My Medicare Prescription Drug Costs?

Medicare offers a program called Extra Help to people with low incomes and limited assets. This is sometimes called Low Income Subsidy or LIS.

 

Learn more about qualifying for Extra Help here.

How to apply for Extra Help

 

Step 1: Choose a drug plan provider

Whether you qualify for Extra Help or not, you must enroll for prescription drug coverage in order to apply for Extra Help.

 

 

Step 2: Complete an application for Extra Help.

The easiest way to apply is to download an application and submit it online. You can also fill out a paper copy. If you haven’t already received a copy of the application by mail, request one toll-free at 1-800-772-1213, 7 a.m. to 7 p.m., Monday through Friday. TTY: 1-877-325-0778.

 

 

Mail completed applications to:

 

Social Security Administration

Wilkes-Barre Data Operations Center

P.O. Box 1020

Wilkes-Barre, PA 18767-9910

 

After submitting your application, you’ll hear within 8 weeks if you qualify for Extra Help with Part D costs.

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You may automatically receive Extra Help

 

If you meet any one of the criteria below, you will automatically receive Extra Help from Medicare to help with your Part D costs. There's no need to apply.

 

  • You receive both Medicare and Medicaid.
  • You receive both Supplemental Security Income (SSI) benefits and have Medicare.
  • The state pays your Medicare premiums.

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If you aren't getting Extra Help, you can see if you qualify by calling:

 

  • 1-800-Medicare (toll-free; TTY/TDD users call 1-877-486-2048), 24 hours a day/7 days a week,
  • Your State Medicaid Office, or
  • The Social Security Administration toll-free at 1-800-772-1213. TTY/TDD users should call 1-800-325-0778 between 7 a.m. and 7 p.m., Monday through Friday.

 

If you have any questions, please contact UnitedHealthcare Customer Service.

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Best Available Evidence Policy

 

The federal Best Available Evidence (BAE) policy requires that the plan adjust your subsidy if you provide updated information that changes the level of Extra Help you receive. A memo on the CMS website explains the procedures for updating a person's level of Extra Help.

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Counting your assets

 

To determine your eligibility, Medicare may also look at your assets. Assets Medicare counts include:

 

  • Cash (including checking and savings accounts)
  • Certificates of deposit
  • Retirement accounts (like IRAs or 401(k)s)
  • Stocks, bonds and mutual funds
  • Promissory notes
  • Property that could be converted to cash within 20 days
  • Mortgages
  • Life insurance policies

 

Medicare does not count these assets:

 

  • Your primary home
  • Your primary car
  • Burial plots or agreements
  • Funds set aside for burial expenses (up to $1,500 per person)

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Premiums for members receiving Extra Help

 

To learn more about plan premiums for people receiving Extra Help, please contact UnitedHealthcare Customer Service.

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State Pharmaceutical Assistance Programs

 

A State Pharmaceutical Assistance Program (SPAP) provides state-funded prescription drug assistance to people who need help paying for their monthly prescription drug plan premiums, deductibles, copays and coinsurance.

 

For most programs, members must meet specific income guidelines and additional requirements that vary by state.

 

To find out how to contact your state SPAP, visit www.medicare.gov/pharmaceutical-assistance-program/state-programs.aspx.

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