Ask the Advisor: November 2017

Ask the Advisor: November 2017

My Sister Is Losing Medicare Extra Help.  What Can We Do?

Q:  My sister has a low income and receives Medicare Extra Help with her drug coverage.  She started Social Security when she turned 66, but she still works part time.   We were both upset when she received notification that she is no longer qualified to receive Extra Help.  Her hours continue to be cut back at work and so her income has remained low.  Is there anything we can do?

A:  Yes, there is action you should take, but you and your sister need to act quickly.  According to the National Council on Aging, people getting Extra Help don’t necessarily lose their eligibility due to changes in income and assets.  Benefits are most often lost because the required paperwork isn’t returned.

Medicare Extra Help is provided for people with limited income and savings.  The program — estimated to be worth about $4,000 a year on average — helps pay monthly drug plan premiums, annual deductibles, and prescription co-payments.  Social Security periodically reviews the status of people who receive Extra Help, and “redetermination” notices are sent out the end of August and September.  If your sister received such a notice, it explains that she may lose her Extra Help at the end of December, unless she takes action before then. 

Along with the notice your sister received in September, Social Security sent a redetermination application for Extra Help along with a postage-paid return envelope.  That form must be completed and returned within 30 days, even if nothing has changed. You can get one 30-day extension by asking the Social Security Administration.

If your sister is losing Extra Help she will have a three-month Special Enrollment Period from January 1 through March 31 to switch to another Part D Prescription Drug Plan or Medicare Advantage Plan with prescription drug coverage.    She will want to act early to prevent a lapse in drug coverage requiring her to pay the costs of her prescriptions out of pocket.

Help is available for re-applying for Extra Help and comparing Part D or Medicare Advantage plans.  We urge you to contact your local area agency on aging or senior social services department.  Your sister can receive free, unbiased, one-on-one counseling through your State Health Insurance Assistance Program (SHIP).  Find a counselor in your area here.

To learn more, read SSA Publication No. 05-10111 “Review of Your Eligibility for Extra Help With Medicare Prescription Drug Plan Costs: Some Things You Should Know.”  For more information about Medicare Extra Help and how to apply visit www.socialsecurity.gov/extrahelp or call Social Security 1-800-772-1213.

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