Extra Help Medicare Review

Pros Explained

• Helps pay Medicare prescription drug coverage costs: Original Medicare doesn't cover prescription drugs, but paying for a Prescription Drug Plan can be too costly for people with lower incomes, leaving many without a way to afford medications. That's where Extra Help comes in by helping low-income Medicare members pay the costs of their Prescription Drug Plan.
• Savings can be significant: You may save approximately $5,000 per year with Extra Help, according to Social Security Administration's 2021 estimates. 
• Some people automatically qualify: If you're eligible for both Medicaid and Medicare, you get help from Medicaid to pay your Medicare Part B premiums through a Medicare Savings Program (MSP), or if you have both Medicare and Supplemental Security Income (SSI), you're automatically eligible for Extra Help. Even if you don't qualify automatically, you can apply to see if you're eligible.

Cons Explained

• Must meet income and asset limits: As of 2022, to qualify for Extra Help, you must earn less than $19,320 for an individual (or $26,130 for a married couple living together) and can’t own more than $15,510 as an individual (or $30,950 for a married couple living together) of certain types of resources. Resources that count toward this limit include real estate other than your primary residence, stocks, bonds, mutual funds, bank accounts, retirement accounts, and cash. Not counted in your resources are your primary residence, vehicles, personal possessions, life insurance policies, burial expenses, and interest on the money you plan to use for burial expenses and any property you use for self-support.
• Can’t combine with Medicare Advantage plans: To use Extra Help subsidies, you must have a Stand-alone Prescription Drug Plan, but you can’t have a Medicare Advantage Plan. If you have your heart set on a comprehensive managed care plan that bundles all your Medicare coverage—which you’d get with Medicare Advantage—you'll have to choose between the two; you can’t have both.

Available Programs

Extra Help is not a Medicare insurance plan but a financial support program to help certain Medicare members pay for their medications. You must live in the U.S. and be enrolled in Original Medicare to qualify for Extra Help. You must also meet financial criteria: The value of your combined savings, investment, and real estate—excluding your home, vehicles, personal possessions, life insurance, burial plots, irrevocable burial contracts, or back payments from Social Security—cannot exceed $15,510, or $30,950 if you live with a spouse as of 2022.

Extra Help helps cover monthly premiums, annual deductibles, and copayments within a Medicare Prescription Drug Plan. To apply for Extra Help, you’ll need to share some information about your income and resources.

Be prepared to apply with your Social Security card, bank account statements (including checking, savings, CDs), Individual Retirement Accounts (IRAs), stocks, bonds, savings bonds, mutual funds, and other investment statements, tax returns, payroll slips, and your most recent Social Security benefits awards letters. You may also need statements from any Railroad Retirement benefits, Veterans benefits, pensions, or annuities.

Even if you don’t have all these documents, you can make your best estimate, and the Social Security Administration can figure out if you’re likely to qualify. You may later need to provide documentation but not necessarily. 

By applying for Extra Help, you also start the process of applying for help from your state with other Medicare costs through the Medicare Savings Programs. The Social Security Administration sends your information to your state, who then gets in touch with you about other savings programs if you qualify. You can opt out of sending your information to your state and still apply for Extra Help.

Customer Service

Applying for Extra Help

You can apply for Extra help online, by phone, or by mail.

Online

Apply online at the Social Security website by filling out the Extra Help Application, https://secure.ssa.gov/i1020/start.

If you start the application but don’t finish it, you can save your work, get a re-entry number, and return to finish your application.

 Telephone

Call 800-772-1213, Monday through Friday, between 8 a.m. and 7 p.m. to apply over the phone. You can also call this number to request a paper application.

Due to the pandemic, your local Social Security Office is likely closed for in-person assistance but may be able to help you apply by phone until they reopen. Find your local office via the Social Security Office Locator.

General Help

You can call 1-800-MEDICARE or visit www.medicare.gov for information on Medicare Savings Programs or Medicare Prescription Drug plans. 

Or you can contact the State Health Insurance Counseling and Assistance Program (SHIP) in your area for help. Find your local SHIP at www.shiphelp.org, call 877-839-2675, or email info@shiphelp.org.

Customer Satisfaction 

Extra Help isn’t specifically reviewed or rated, but overall, Medicare members report a high level of satisfaction with their Medicare prescription drug coverage. According to a 2021 Medicare beneficiary survey, 87% said they were satisfied with prescription drug coverage, and 85% said their Medicare Part D Prescription Drug Plan provided good value. Most respondents reported being able to afford their Prescription Drug Plan costs; 84% of those surveyed said their monthly Prescription Drug Plan premiums are affordable, and 76% said their out-of-pocket costs are reasonable.

Cost

While Medicare Prescription Drug Plans vary in costs by carrier, geography, and level of coverage, there is no cost to join the Extra Help program. The best way to find specific Prescription Drug Plan costs is to visit Medicare.gov and compare options in your area.

Competition: Extra Help vs. Humana 

Extra Help is not Medicare insurance but a financial assistance program for Medicare members who have trouble affording their Prescription Drug Plan costs. To get Medicare insurance for prescription drugs, most Medicare Advantage plans offer drug coverage, and many insurers offer Stand-alone Prescription Drug Plans.

To qualify for Extra Help, you’ll have to choose a Prescription Drug Plan. Check out Humana, which offers Medicare plans in 85% of U.S. counties, the most of any Medicare insurer. Humana offers three types of Stand-alone Prescription Drug Plans, including the Humana Basic Rx Plan, which is ideally suited for people who qualify for Extra Help. Premiums in this plan range from $19.70 to $45.00 per month; many drugs across tiers have $0 or very low copayments.

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How We Reviewed Medicare Providers

Even Medicare health plans with a national presence can vary locally in their cost, quality, and customer satisfaction. To evaluate Medicare plans, we looked at health insurance industry ratings from the primary accrediting agency for health plans, National Committee for Quality Assurance (NCQA), and the Medicare Star Ratings from CMS, the regulatory agency that oversees Medicare. We included the National Association of Insurance Commissioners’ complaint index and AM Best’s financial stability ratings. We also considered information from the companies on their programs and strategies.