For many Medicare beneficiaries, the cost of prescription medications is a significant part of their budgets. While the Medicare Prescription Drug Plans (PDPs) have greatly lowered the expense, premiums and copayments still add up quickly. And for those who take high-priced drugs, there is always the specter of the “donut hole” looming.
Less-than-wealthy people who receive Medicare benefits might well be eligible for assistance, and they are not aware that help is available. As part of the Health Care Reform Act that gave birth to the PDPs, a program named Extra Help was initiated to assist even more with medication expenses.
Extra Help is funded by insurance companies and pharmaceutical manufacturers, not tax dollars. It helps in the following ways: with a full or partial subsidy of PDP premium expenses; with reduced copayments at the drugstore; and no one who is receiving Extra Help can fall into the “donut hole” and be charged an increased copayment because their drug costs are higher than average.
Qualifying income and assets are quite generous, and the application is very simple. A single person cannot have income from wages, self employment, Social Security, Railroad Retirement, VA benefits, pensions, annuities, alimony, rental income and/or worker’s compensation of more than $17,235 a year (about $1,436 a month.) For married persons living together, the combined income cannot exceed $23,265 a year (about $1,939 a month.)
Single persons cannot have more than $13,300 in assets; married couples cannot exceed $26,580. Resources that are counted toward these limits include cash at home, bank accounts, individual retirement accounts, stocks, bonds, mutual funds, promissory notes, and real estate other than the primary residence. NOT counted as available resources are the primary residence and the land it is on, personal possessions, vehicles, jewelry, prepaid burial expenses and burial plots, life insurance policies, property of a trade or business needed for self-support, and money received from governmental agencies for housing assistance and medical and/or social services.
Once an individual is approved for Extra Help, the assistance will be in place for the entire calendar year, unless there is a change in marital status. Some people will need to furnish updated information each year to maintain Extra Help; others’ assistance is renewed automatically.
Applying for Extra Help can be done online, or using a paper form available from the Social Security Administration. The application does not require that additional documents like bank statements or income letters be included (although the information on those documents must be entered on the form,) and takes about 15 minutes to complete.
Applications can be filed on Social Security’s website: http://www.ssa.gov/prescriptionhelp/. Paper copies of the application can be obtained by calling Social Security at 800-772-1213. Individuals who think they or their loved ones may be eligible for Extra Help can also call Maury River Senior Center to schedule an appointment with a state-certified Medicare Insurance Counselor. Using the information provided by the individual, counselors can complete the application in very little time; decisions are generally received on eligibility within 4 weeks.
To schedule an appointment for apply for Extra Help, or for assistance with other Medicare-related topics, interested persons should call MRSC at 261-7474.
More online at www.MauryRiverSeniorCenter.org.
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