Q: Are there any special Medicare programs that help seniors with their medication costs? My 74-year-old mother, who lives primarily on her Social Security, takes several high-priced drugs that sap her income even with her Medicare drug plan.
A: Yes, there’s a low-income subsidy program called Extra Help that can assist seniors on a tight budget with paying for their premiums, deductible and co-payments in their Medicare (Part D) prescription drug plan. Currently around 10 million people are receiving this subsidy, but another 2 million may qualify for it and don’t even realize it. They’re missing out on hundreds, maybe thousands, of dollars in savings each year.
Changes in the law make it easier than ever to qualify for the Extra Help program. Even if your mom applied and didn’t qualify before, she may be eligible now. The amount of additional assistance she would receive depends on her income and assets. If she qualifies for help, she’ll pay no more than $3.35 for a generic drug and $8.35 for a brand-name drug in 2018.
To get the subsidy, your mom’s assets can’t be more than $14,100 (or $28,150 for married couples living together). Bank accounts, stocks and bonds count as assets, but her home, vehicle, personal belongings, life insurance and burial plots do not. Also, your mom’s monthly income can’t be more than $1,538 (or $2,078 for married couples). If your mom supports a family member who lives with her, or lives in Alaska or Hawaii, her income can be higher. In addition, the government won’t count any money if your mom receives help for household expenses like food, rent, mortgage payments, utilities and property taxes.
There are three ways to apply for Extra Help: online at SSA.gov/prescriptionhelp; by calling Social Security at 800-772-1213; or by visiting her local Social Security office.
The application form is easy to complete, but you’ll need your mom’s Social Security number and information about her bank balances, pensions and investments. Social Security will review her application and send her a letter within a few weeks letting you know whether she qualifies.
If your mom doesn’t qualify for Extra Help, she may still be able to get help from a state pharmacy assistance program or a patient assistance program. Visit BenefitsCheckUp.org and click on “Medications” to search for these programs.
If your mom is eligible for Extra Help, she may also qualify for help with her other Medicare expenses through her state’s Medicare Savings Program.
State Medicaid programs partner with the federal government, so income and asset qualifications vary depending on where she lives. Medicare Savings Programs will pay her entire Medicare Part B premium each month. Some also pay for Part B coinsurance and copayments, depending on her income. Contact your mom’s state Medicaid office to determine if she qualifies for benefits in her state.
You can also get help through her State Health Insurance Assistance Program (SHIP), which provides free one-on-one Medicare counseling in person or over the phone. To locate a SHIP counselor in your area, visit ShiptaCenter.org or call the eldercare locator at 800-677-1116.
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