Medicare provides “Extra Help” to pay prescription drug costs for people who have limited income and resources. Resources include your savings and stocks, but not your home or car. If you qualify, you get help paying for any Medicare drug plan’s monthly premium, yearly deductible, and prescription copayments. This “Extra Help” also counts toward your out-of-pocket costs.
Applying for Extra Help with Medicare
If you automatically qualify for “Extra Help” Medicare will mail you a letter. You will not have to apply. If you do not automatically qualify you may be able to get “Extra Help” to pay for your prescription drug premiums and costs. To see if you qualify for getting “Extra Help,” call:
- 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048, 24 hours a day/7 days a week;
- The Social Security Office at 1-800-772-1213, between 8 a.m. to 7 p.m., Monday through Friday. TTY users should call 1-800-325-0778 (applications); or
- Your State Medicaid Office (applications) (See Section 6 of your Evidence of Coverage booklet for contact information).
If you believe you have qualified for “Extra Help” and you believe that you are paying an incorrect cost-sharing amount when you get your prescription at a pharmacy, our plan has a process for you to either request assistance in obtaining evidence of your proper copayment level, or, if you already have the evidence, to provide this evidence to us.
- Send a letter to us describing why you qualify for Extra Help and include any letters you have received. Mail the information to P.O. Box 240, Columbia, Tennessee 38402
- When we receive the evidence showing your copayment level, we will update our system so that you can pay the correct copayment when you get your next prescription at the pharmacy. If you overpay your copayment, we will reimburse you. Either we will forward a check to you in the amount of your overpayment, or we will offset future copayments. If the pharmacy hasn’t collected a copayment from you and is carrying your copayment as a debt owed by you, we may make the payment directly to the pharmacy. If a state paid on your behalf, we may make the payment directly to the state. Please contact Member Services if you have questions.
What if you have coverage from a State Pharmaceutical Assistance Program (SPAP)?
You are automatically eligible for Extra Help if:
- You are eligible to receive both Medicare and Medicaid (dual eligibility)
- You have a Medicare Savings program (partial dual eligibility)
- You receive Supplemental Security Income (SSI) benefits but not Medicaid
Click here for the Social Security Administration's publication "Understanding The Extra Help With Your Medicare Prescription Drug Plan".
Click here for more information about Medicare's Extra Help program.
Click on Plan Year 2023 for a summary of monthly plan premiums for those eligible for extra help.
In most cases, you will need to apply for Extra Help either through the Social Security Administration or through your state Medicaid Office. After you apply, Social Security will review your application and will send you a letter to let you know if you qualify for Extra Help.
Records you will need to complete the Extra Help Application include:
- Statements that show your account balances at banks, credit unions or other financial institutions;
- Investment statements and stock certificates;
- Tax returns;
- Pension award letters; and
- Payroll slips.
Using the Best Available Evidence Policy (BAE)
If your Low Income Subsidy (LIS) information is incorrect, you can use the Best Available Evidence (BAE) policy to show that you qualify. You can use such evidence as your award letter from Social Security Administration, your Medicaid card or other proof of your eligibility for Extra Help. When you provide this information to your Medicare Prescription Drug Plan, your plan will update your Low Income Subsidy information as soon as possible.