top of page
  • Writer's picture

Medicare Prescription Drug Extra Help Program

Prescription Drug Extra Help (also called Low Income Subsidy) is a program that Social Security uses to help low-income earners with Medicare cover their Medicare prescription drug costs. The help they render can be related to annual deductibles, monthly premiums, and prescription co-payments related to a Medicare prescription drug plan. One thing to know is that the Extra help is worth approximately $5,000 per annum, which is huge for most low-income earners.

However, the questions remain; who qualifies for this? Where can those that are eligible apply? What does this mean for those that are eligible? These are some of the questions that we will be answering in this article. In the end, you would have learned a lot about the Prescription Drug Extra Help program.

Who Qualifies for Prescription Drug Extra Help?

There are some criteria to meet before qualifying for the Prescription Drug Extra Help. The first one is that they must be living in the United States of America or the District of Columbia. Secondly, the individual must have Medicare Part A (Hospital Insurance), Medicare Part B (Medical Insurance), or both. Furthermore, the person or persons' resources and income must not exceed the limits.

Resource Limit

The resource limit to qualify for Prescription Drug Extra Help in 2021 is $14,790 and $29,520 for individuals and married couples living together, respectively. Resources in this instance are referred to as things or assets an individual owns. Some of these include real estate excluding primary residence, stocks, bonds, mutual funds, personal cash, bank accounts, and Individual Retirement Accounts. The total value of these is what is known as RESOURCES.

However, some things do not count as Resources. Some of these include vehicles, the primary home of residence, furniture, life insurance policies, etc.

Income Limit

The income limit needed to qualify for Prescription Drug Extra Help is an annual income of $19,320 and $26,130 for individuals and married couples living together, respectively. However, there are some cases where even if your income is higher than the limit, you can still qualify for the Prescription Drug Extra Help. Examples of these situations are living in either Alaska or Hawaii or supporting a family member living with you financially.

Besides, it would help if you remembered that not every income or cash receipt counts towards the income limit. Examples of cash payments that do not count are:

· Educational grants or scholarships

· Financial assistance from other people for payment towards house expenses

· Food stamps

· Housing assistance

· Home power assistance

It is worth noting that resource and income limits can change yearly. A review would be warranted if you would like to apply for this program.

Is There an Automatic Qualification For Extra Help?

Everyone enrolled in Medicaid, Supplemental Security Income, or any Medicare Savings Program automatically qualifies for Extra Help. Moreover, not meeting the requirements for Extra help doesn't matter in this instance. Besides, with the automatic qualification, you do not need to apply for Extra Help as you will receive a notice from CMS informing you about this.

How To Apply For Extra Help

Applying for Prescription Drug Extra Help is relatively easy. First, you need to know that you automatically qualify for Extra Help if you have Medicaid, Supplemental Security Income, or a Medicare Savings Program. In a situation where you do not, you can apply for the Extra Help Program by completing the Social Security’s Application for Extra Help online through

Another way to apply is by calling the Social Security Number 1-800-772-1213 to apply over the phone. Finally, you can also apply for Extra Help at your local Social Security office. After the application, SSA will review your application and send you a letter telling you if you qualify or not. Upon successful qualification, you can now choose a Medicare prescription drug plan. However, if you do not select a plan, CMS will do that for you.

What To Do If The Application For Extra Help Is Declined?

Sometimes, SSA might decline your application for extra help. Other times, SSA might not give you the benefits you think you deserve. There are two ways in which you can appeal to these.

Before The Final Decision

Before you get a denial, you will get a 'pre-decisional notice.' The notice will explain why you are not eligible for Extra Help and why your application would be denied. If you feel SSA rejected your application because of incorrect information, you can always correct it. However, you only have ten days from the date on the notice you received to make the corrections. Visiting your local SSA office or placing a call through might be your fastest option to resolve the issue.

After The Final Decision

After SSA makes its final decision, you can appeal the decision if you are not satisfied with the outcome. Check out the steps for appealing below:

1. Request a hearing within 60 days of when you receive the notice of the final decision. You can also request that an SSA agent reviews your application, including any other information you provide for the case.

2. Set a date for the hearing by calling SSA's national hotline: 800-772-1213 or by contacting your local SSA office.

3. You will receive a notice in your mail to confirm the date of your hearing, including a toll-free number to call. Finally, ensure you participate in the hearing on the set date. The hearings will be held on the phone.


bottom of page