For Medicare recipients who are struggling to pay prescription drug costs, the Extra Help program from the Social Security Administration may be of assistance. Extra Help can save seniors as much as $4,000 per year. Extra Help is not available to everyone, however: there are certain criteria for eligibility.
Eligibility for extra help for Medicare recipients
Given that Extra Help exists to assist certain Medicare recipients, it probably goes without saying that a person must be on Medicare before Extra Help is available. However, being on Medicare is not in and of itself enough. There are two more hurdles to go over in order to be eligible for Extra Help.
The first–and most challenging–requirement deals with an applicant’s resources and income level. For an elderly person who is single, his or her assets must not total more than $13,640. If he or she is married, the value of the couple’s assets must be less than $27,250.
Assuming an elderly person’s assets are lower than the above figures, the next step is considering his or her income. Extra Help is only available to those individuals whose annual income is less than $17,820; a couple’s combined income must be under $24,030.
Note that the limitations on income are not absolute. An elderly person may still qualify for Extra Help even if he or she exceeds the income threshold if the person is supporting other family members who live with him or her. Other exceptions are if the elderly person derives at least part of his or her income from earnings from work, or if he or she lives in Hawaii or Alaska. If any of these apply, someone on Medicare whose income exceeds the threshold may still be able to get Extra Help.
Assuming that financial issues do not preclude Extra Help, there is still another consideration: geographic location. Although there is no reason that U.S. citizens and other beneficiaries of Medicaid cannot live wherever they choose, Extra Help is only available to residents of one of the fifty states or the District of Columbia. If an elderly person is considering moving to a U.S. protectorate such as Puerto Rico, American Samoa, or any other of a number of other territories, he or she and family members might want to reconsider this move in light of eligibility for Extra Help. Such a move would render the person ineligible for it.
Getting extra help
Once someone qualifies for Extra Help, the next step is actually getting it. As with many government programs, merely being qualified doesn’t mean that a person will actually receive anything unless he or she completes the appropriate forms and follows the necessary procedures.
The Application for Extra Help with Medicare Prescription Drug Plan Costs (SSA-1020) must be completed. This form is available on the Social Security website. It will ask the necessary questions to allow the Social Security Administration to evaluate an application.
The form is available online at www.socialsecurity.gov/extrahelp.
As many older people prefer, however, they can call Social Security to apply. You can complete the form over the phone or request an application by mail. The number to call is 1-800-772-1213. Finally, if neither of these options are workable, any local Social Security office will accept applications submitted there.
Of all the above options, applying online is probably the best one for a number of reasons. The online application is user-friendly and will help walk a person through the application process.
Some older people are uncomfortable using computers. A more tech-savvy family member or caregiver may need to help complete the application.
What is the next step after applying?
After the Social Security Administration has evaluated an application and approved it for Extra Help, the applicant will need to browse the various Medicare prescription plans and select one. If he or she is unable to select a plan, the Medicare administrative staff will choose one.
If an elderly person is struggling to pay for medication, there is no need to despair. There are options available. Extra Help is one of them.
Neuman, P., Strollo, M.K., Guterman, S., Rogers, W. H., Li, A., et al. (2007). Medicare Prescription Drug Benefit Progress Report: Findings from A 2006 National Survey of Seniors. Health Affairs, 26(5): w630-w643. Available at http://content.healthaffairs.org/content/26/5/w630.full.pdf+html. Retrieved September 20, 2016.
Davis, K., Moon, M., Cooper, B., Schoen, C. (October 4, 2005). Medicare Extra: A Comprehensive Benefit Option for Medicare Beneficiaries. Health Affairs, Web Exclusive, w5-442-w5 -454. Available at http://content.healthaffairs.org/content/early/2005/11/15/hlthaff.w5.442.full.pdf+html. Retrieved September 20, 2016.
Social Security. Extra Help with Medicare Prescription Drug Plan Costs. Available at https://www.ssa.gov/medicare/prescriptionhelp/. Retrieved September 20, 2016.