Help with drug costs

"Extra Help" is a Medicare program to help people with limited income and resources pay Medicare drug coverage (Part D) premiums, deductibles, coinsurance, and other costs. What's a premium, deductible, coinsurance, or copayment?

You also won't have to pay a Part D late enrollment penalty while you get Extra Help. What's the Part D penalty?

Some people qualify for Extra Help automatically, and other people have to apply.

Extra Help isn't available in Puerto Rico, the U.S. Virgin Islands, Guam, the Northern Mariana Islands, or American Samoa. But there are other programs available in those areas to help people with limited income and resources. Programs vary in these areas. Call your State Medical Assistance (Medicaid) office to learn more.

Who gets Extra Help automatically?

You'll get Extra Help automatically if you get:

• Full Medicaid coverage
• Help from your state paying your Part B premiums (from a Medicare Savings Program )
• Supplemental Security Income (SSI) benefits from Social Security

You'll get a letter about your Extra Help. It tells you things like how much you'll pay, and your new Medicare drug plan, if you don't have one already.

If you don’t automatically get Extra Help, you can apply for it:

You can also contact your local State Health Insurance Assistance Program (SHIP) to get free help applying.

You can apply for Extra Help and Medicare Savings Programs (MSPs) at the same time. These state programs provide help with other Medicare costs. Social Security will send information to your state to initiate an MSP application unless you tell them not to on the Extra Help application. Learn more about Medicare Savings Programs.

Who should apply for Extra Help?

In most cases, to qualify for Extra Help, you must have income and resources below a certain limit. These limits may go up each year.

Income and resource limits in 2024:

What are the income and resource limits if I live in Alaska or Hawaii?

If you qualify for Extra Help

We’ll automatically enroll you in a Medicare drug plan (Part D) , if you don’t have one already. We do this so you can get the cost savings you qualify for.

• You’ll get a letter telling you:
  • About your new plan. You can pick a different Medicare drug plan if you want.
  • That you get Extra Help for the rest of the calendar year. Even if your income changes in the middle of the year, you’ll keep getting Extra Help through December 31.
  • You no longer qualify for Extra Help.
  • You get moved to a different plan for next year.

  What you'll pay under Extra Help in 2024

  • Plan premium: $0
  • Plan deductible: $0
  • Prescriptions:
    • Up to $4.50 for each generic drug
    • Up to $11.20 for each brand-name drug

    Once your total drug costs (including certain payments made on your behalf, like through the Extra Help program) reach $8,000, you’ll pay $0 for each covered drug.

    If you also get full Medicaid coverage and are in the Qualified Medicare Beneficiary (QMB) program, you’ll pay no more than $4.60 for each covered drug. Find out if you may qualify for QMB or other Medicare Savings Programs.

    Even if you don’t qualify for Extra Help now, you can reapply for Extra Help any time if your income and resources change.

    Do you think you're paying the wrong amount for your prescription(s)?

    If you qualify for Extra Help and think you’re paying the wrong amount, here’s what you can do:

    • Contact your drug plan. Your plan may ask for proof that you get Extra Help so they can correct your costs. Get examples of proof .

    Tell your plan how many days of medication you have left. Your plan and Medicare will try to fix your issue before you run out of your medication.

    • Call us at 1-800-MEDICARE (1-800-633-4227). TTY users can call 1-877-486-2048. We can tell you your level of Extra Help and help you get your costs fixed with the plan.

    You may be able to get some money back if you:

    • Paid for prescriptions after you qualified for Extra Help
    • Aren’t in a Medicare drug plan

    Keep your receipts with your prescription drug prices, and call Medicare's Limited Income Newly Eligible Transition (LI NET) Program at 1-800-783-1307. TTY users can call 711.

    Other ways to lower your prescription drug costs:

    • Join Medicare drug coverage (Part D):
      • Compare Medicare drug plans to find a plan with lower drug costs.
      • Check if the company that makes your drug offers help paying for it.
      • Find out if your state offers help with drug costs.

      What do you want to do next?

      • Next Step: Learn about other health plans that lower costs
      • Take Action: Apply for Extra Help
      • Get details: Review sample letters about Extra Help