Medicare Provides Assistance to Help Low-Income Beneficiar​ies Get Big Savings on Prescripti​on Drug Costs

Some Medicare beneficiaries could qualify for assistance with their prescription drug costs, and be eligible this year to pay no more than $2.50 for generic drugs and $6.30 for each brand name drug. The steps and requirements beneficiaries can take to check if they qualify for the Medicare Low-Income Subsidy Program (also known as LIS or “Extra Help”) are simple and may be done by phone or online.

The Centers for Medicare & Medicaid Services estimates that more than 2 million people with Medicare may be eligible for the subsidy, but are not currently enrolled to take advantage of these savings.

Changes resulting from the Medicare Improvements for Patients and Providers Act (MIPPA) of 2008 made it easier for Medicare beneficiaries to qualify for “Extra Help” by changing the way income and assets are counted. As of last year, the Social Security Administration, which determines eligibility for the program, does not count life insurance policies as a resource for eligibility purposes. In addition, help received from family and friends to pay for household expenses like food, mortgage, rent and utilities does not count as income.

“The eligibility requirements are more flexible than they were a couple of years ago, ‘Extra Help’ can be lifesaving for someone who needs prescription drugs and needs help with the cost,” said Dr. Don Berwick, CMS Administrator. “If you were turned down for ‘Extra Help’ in the past due to income or resource levels, you should reapply. If you qualify, you will receive help paying for Medicare prescription drug coverage premiums, copayments and deductibles.”

To qualify, Medicare beneficiaries’ incomes must be less than $16,335 a year (or $22,065 for married couples) and have resources limited to $12,640 (or $25,260 for married couples). Resources include bank accounts, stocks, and bonds, but do not include a beneficiary’s house, car, or life insurance policy.

There is no cost to apply for “Extra Help.” Medicare beneficiaries, family members, trusted counselors or caregivers can apply online in English and Spanish at www.socialsecurity.gov/prescriptionhelp. Beneficiaries may also call the Social Security Administration at 1-800-772-1213 (TTY users should call 1-800-325-0778) and ask for the Application for Medicare’s Part D Extra Help.

Medicare beneficiaries can also receive assistance in their local communities from their State Health Insurance Assistance Program (SHIP), Area Agencies on Aging (AAA), the Aging and Disability Resource Centers (ADRC) and many tribal organizations. For information about contacting your AAA, ADRC or SHIP go to www.eldercare.gov. Local SHIP contact information can be found online at www.medicare.gov/contacts/organization-search-criteria.aspx. All information provided is confidential.

To learn more about Medicare prescription drug coverage, visit www.medicare.gov, or call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048.

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Dallas L Alford IV, CPA is a licensed Certified Public Accountant in the state of North Carolina and owner of Atlantic Financial Consulting, a consulting firm that provides comprehensive medical billing services, practice management consulting, coding audits, Medicare compliance, Medicare RAC support and other general medical practice consulting services.

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