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Medicare’s Extra Help Program and the Affordable Care Act

Anyone who has Medicare is allowed to also obtain Medicare’s prescription drug coverage. But for those who have a limited amount of income or other financial resources, it may be possible to qualify for help with health care and prescription drug costs through Medicare’s Extra Help program.

Extra Help is a program through Medicare that is designed for helping individuals with payment of their prescription medication expenses, such as your deductibles and coinsurance, and even with the premiums that you pay on your Medicare Part D prescription drug plan coverage.

While many people feared that the Affordable Care Act would change or alter these cost savings or assistance programs in some way, the good news is that the new law did not change these options.

How Do You Qualify for Medicare’s Extra Help Program?

In order to qualify for the Extra Help program, you must meet the following criteria:

  • You must be a resident of one of the 50 U.S. states or the District of Columbia, and
  • You must have limited financial resources.

In 2014, Medicare’s qualification criteria in terms of limited financial resources is as follows:

  • First, for an individual, your total resources, including your funds within a bank and investment accounts, must be limited to $13,440 or less. For a married couple who is living together, this amount is $26,860. It is important to note that the value of your home, car, and life insurance policy (or policies) are not counted as resources.
  • In addition, your annual income must also be limited. For an individual, this amount must be at or below $17,235 and for a married couple living together this amount must be at or below $23,265. If, however, the amount is higher, it may still be possible to receive some amount of assistance from Extra Help.

Applying for Extra Help

In order to apply for Medicare’s Extra Help program, there are several options. You can do so by visiting a Social Security office in person. You may also opt to do so by contacting Social Security by phone, or by going to the Social Security website via the Internet.

Once your application for Extra Help has been reviewed, you will be notified as to whether or not you have qualified. If so, you will be allowed to choose a Medicare prescription drug plan. If you do not choose a plan, Medicare will choose a plan for you.

What About the Medicare Savings Programs?

At the time that you file your Extra Help application, you may also apply for the Medicare Savings Programs as well. These state programs are available to assist you with other Medicare related expenses. In certain cases, these programs can help you with paying for your Medicare Part A and Part B deductibles and co-payments.

There are four different Medicare Savings options available through the Medicare Extra Help program. These include the following:

  • Qualified Medicare Beneficiary Program
  • Specified Low Income Medicare Beneficiary Program
  • Qualifying Individual Program
  • Qualified Disabled and Working Individuals Program

You may qualify for one or more of these programs, depending on your particular circumstances.  At we are here to assist you and make sure you get the best rates on all facets of Medicare, so contact us if you have any questions.

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