What is Extra Help and do I qualify?
Extra Help lowers what you pay for Medicare drug coverage. Social Security sets the limits each year and decides who qualifies.
- Extra Help is a federal program that lowers what you pay for Medicare drug coverage, and Social Security decides who gets it.
- It is based on your income and your resources, meaning savings and investments, and the limits are set again each year.
- There are two applications, one for Extra Help through Social Security and one for a Medicare Savings Program through Texas.
Extra Help is a federal program that lowers what you pay for your Medicare drug coverage. Its formal name is the Low Income Subsidy. Social Security decides who qualifies, based on your income and your savings.
What Extra Help does
Part D is the part of Medicare that pays for prescriptions. For people who qualify, Extra Help does this.
- Lowers or wipes out your Part D premium, the monthly bill for the coverage.
- Lowers or wipes out your yearly deductible, the amount you pay yourself before the plan starts paying.
- Holds what you pay at the pharmacy counter to small set amounts.
- Cancels the Part D late enrollment penalty, the extra charge added on for going without drug coverage.
- Gives you more chances to change plans during the year, instead of waiting until October.
The penalty part matters. If you have stayed away from Part D because a penalty piled up, Extra Help removes it.
Who qualifies: income and resource limits
Social Security looks at your income and at your resources, meaning money in the bank and money you have invested.
Your home does not count as a resource. Neither does your car, and neither do your personal belongings.
The limits are set again every year, so they move. They are also higher than most people expect. That is why so much of this help goes unclaimed. People rule themselves out without asking.
Do not decide on your own that you earn too much. Applying costs you nothing, a denial carries no penalty, and the form is short. Let Social Security look at your numbers.
Automatic qualification
Some people get Extra Help without applying. That happens if any one of these is true for you.
- You have full Medicaid, the state and federal program for people with low income.
- You are in a Medicare Savings Program, a state program that helps pay your Medicare costs. Texas calls these QMB, SLMB and QI.
- You get Supplemental Security Income, a monthly Social Security payment for people with little income and little savings.
So a Medicare Savings Program is worth applying for on its own. It pays the premium for Part B, the part of Medicare that covers doctor visits. It brings Extra Help with it. See how these programs work in Texas.
How to apply
- Apply for Extra Help through Social Security, at ssa.gov, by phone, or at the local office. The form is short.
- Apply for a Medicare Savings Program separately, through Texas Health and Human Services at yourtexasbenefits.com. Different agency, different form.
- Have your income information ready, along with a rough number for your savings and investments.
- If you are turned down, ask why. Sometimes it is a missing document rather than a real problem.
After you are approved
You can keep the drug plan you have, or pick a different one. The help follows you to the plan you choose.
Some plans suit people with Extra Help better than others. Go over your plan once you are approved instead of assuming it still fits.
You also get more chances to change plans during the year.
Why this matters in South Texas
Plenty of people in Hidalgo County would qualify for Extra Help, for a Medicare Savings Program, or for both. Every unenrolled month comes out of a Social Security check that is already stretched.
If you are not sure where you stand, ask Social Security to look at your numbers, and read Part D when you also have Medicaid. We can go through the forms with you. Call our McAllen office at (956) 687 3334, or enter your ZIP code in the plan pricing box on this page.
Common follow-up questions
Does my house count against me?
No. Your home does not count as a resource. Neither does your car, and neither do your personal belongings.
Will Extra Help remove my late enrollment penalty?
Yes. The Part D late enrollment penalty, the extra charge added on for going without drug coverage, is waived while you have Extra Help.
Do I apply through Medicare or Social Security?
Extra Help goes through Social Security. A Medicare Savings Program goes through Texas Health and Human Services. They are separate applications, both worth doing.
Want this looked at properly?
We are an independent agency in McAllen serving Hidalgo, Cameron and Starr counties. There is no obligation to talk it through.
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Gerino Alejos
Licensed insurance agent · License 3128710 · NPN 18243381
Owner of McAllen Insurance Group, an independent agency on North 10th Street in McAllen. Works with clients across Hidalgo, Cameron and Starr counties on Medicare, Marketplace health, life and auto coverage. Se habla español.