When You Can’t Afford Your Prescription Drugs, Apply For “Extra Help”
We’ve heard stories about cutting back on prescriptions over the years, but recently I heard one about a diabetic who was forced to cut back on the amount of insulin that she needed to control blood sugar. She was going into debt to buy Lantus insulin. Cutting back, and not taking the recommended dosage to control her blood sugar, triggered severe nerve pain and sent the woman back to her doctor.
Nearly two-thirds of the spending on prescription drugs by older Americans is for out-of-pocket costs that include deductibles, co-pays and co-insurance. Since the start of Medicare Part D in 2006, out-of-pocket costs grew 188% or roughly 16% per year by the end of 2017, far exceeding the growth in Social Security benefits, that averaged just 1.9% per year over the same period.
If you find yourself in the situation where it’s getting difficult to afford your prescriptions, Medicare has a program known as “Extra Help,” that pays for some or even most of your out-of-pocket drug costs. You qualify if your monthly income is less than $1,538 for individuals or $2,078 for couples, and your assets are lower than the specified amount (see chart below):
Do You Qualify For Medicare Part D Extra Help?
|Single||Less than $18,456||Less than $14,100|
|Married||Less than $24,936||Less than $28,150|
- Extra Help pays for your Part D plan premium, up to a specific amount, based on your state.
- Reduces the costs of your drugs.
- Gives you Special Enrollment Periods to enroll or change plans during the year outside of the fall Open Enrollment period.
- Eliminates the Part D late enrollment penalty if you delayed signing up for Part D when you first qualified.
The amount you receive depends on your income and assets. If your income is on the higher end you still might qualify for partial Extra Help. Keep in mind that to receive the assistance you must first enroll in a drug plan AND the drugs you take must be listed on the plan’s formulary.
To learn more and to apply, visit the Social Security website at https://www.ssa.gov/benefits/medicare/prescriptionhelp/. Or call toll free at 1-800-772-1213 (TTY 1-800-325-0778).
You can also get one-on-one counseling and assistance in applying through your State Health Insurance Program (SHIP). Find the contact for your area online at: http://shiptacenter.org.
“Extra Help Basics,” Medicare Interactive, The Medicare Rights Center, accessed on June 19, 2018.