Extra Help from Medicare

Verus Health Partners can help you determine if you are eligible for extra help from Medicare based on your income and other factors.

Medicare Extra Help

If you are struggling with Medicare costs or deductibles and you meet certain criteria, there may be extra financial help available to you.  Read on to learn about this program and if you qualify.  We are always available to help answer your questions.

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Extra Help from Medicare Basics and Eligibility

There is a lot of confusion between Medicare, Medicare, SSI, VA Benefits, and other government run health care related programs. Many people don’t know that Extra Help from Medicare is available. This program is aptly named “Extra Help”. This federal program helps pay for most of the costs of Medicare prescription drug coverage. It also is commonly knows as Medicare Part D.

Eligibility for Extra Help is primarily determined by your monthly income. In 2019 if you earn less than $1,581 a month ($2,124 for married couples) you may be eligible for Medicare Part D. Your assets also must be below the current specified limits to qualify.


There are times when even if your income or assets exceed the established limits, you possibly could still qualify for Extra Help. This generally occurs because certain types of income or assets may not be counted with regard to eligibility.

This who are already enrolled in Medicaid, Supplemental Security Income (SSI) or a Medicare Savings Program automatically qualify for Extra Help from Medicare. Be on the look out for a purple colored notice to let you know you do not need to apply for Extra Help.

Extra Help from Medicare Benefits

The federal Extra Help plan includes the following benefits:

  • Pays for your Part D premium up to a state-specific benchmark amount
  • Lowers the cost of your prescription drugs
  • Gives you a Special Enrollment Period (SEP) once per calendar quarter during the first nine months of the year to enroll in a Part D plan or to switch between plans (You cannot use the Extra Help SEP during the fourth calendar quarter of the year (October through December). You should use Fall Open Enrollment during this time to make prescription drug coverage changes.)
  • Eliminates any Part D late enrollment penalty you may have incurred if you delayed Part D enrollment.

Income and Assets

Based on your income and qualifying assets, you may be eligible for full or partial Extra Help. Both options provide financial assistance for the cost of prescription drugs, given they are required and you use pharmacies inside of your network.

Keep in mind Extra Help is not a full replacement for Medicare Part D or a plan itself. You need to currently have Part D to receive assistance. If a plan is not chosen, you will likely be automatically enrolled in one.

Making the Right Choice

It is important to evaluate if Extra Help is the right choice for you. This is particularly true when you have other coverage regarding prescription drugs. It is possible to lose other benefits you have when enrolling in Medicare Part D or Extra Help. We recommend you speak with your current coverage provider, former employer or union before enrolling. We can also help you determine what questions to ask and whom you need to speak with before making a decision.

There are further considerations if you are with Medicaid and other employer, union, or retiree drug coverage plans. Often times these disqualify you from applying for Extra Help. It is possible to switch to Medicare Part D in the future, then apply for Extra help if you would like.

Verus Health Partners Can Help

At Verus Health Partners, we advocate for all of our clients.  Our goal is to ensure you have the proper coverage for your situation.  Contact us today to learn more about Extra Help from Medicare and other insurance related programs.  You can follow us on Facebook for other helpful information.

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