Extra Help with Medicare Costs

If you have limited income and resources, you may get extra help with Medicare costs including your prescription drug coverage premium and out-of-pocket costs.

The federal government says millions of Americans - about one in three people with Medicare - qualify for extra help with Medicare costs associated with the new prescription drug coverage. You could be one of them, but you have to apply to find out.

You may qualify for assistance

If you participate in Medicare plus another program - i.e., Medicaid, PACE, a Medicare Savings Program, or SSI - you'll receive help with some Medicare costs automatically.

You can apply for help if you don't qualify automatically. An online calculator can help you find out if you're eligible. Even if you're not sure, it may be worth your time to apply.

The simple, four-page application is available at your local Social Security Administration office. You can also get an application form by calling Social Security's toll-free number: 1-800-772-1213, Monday - Friday, 7 a.m. to 7 p.m. (TTY: 1-800-325-0778).

Or you can apply online:

Go to the SSA Webpage Help With Medicare Prescription Drug Plan Costs
Click the button at the bottom right labeled Apply Now
Read the page and click Continue
Answer some questions about your assets and sources of income (if you used the online calculator, your computer may skip this part)
Enter information about yourself, your spouse, and how you can be reached
Review your application, submit it, and print your "receipt"

The application is secured, which means only you and the Social Security Administration can see the information you provide.

What do the programs include?

Help with prescription drug costs - With the new prescription drug coverage, the federal government is helping millions of Medicare beneficiaries pay their prescription drug costs. Those who qualify for extra help will enjoy free or reduced drug coverage premiums and reduced out-of-pocket costs. Some people qualify for prescription drug help automatically, while others need to apply.
Medicaid - This joint state and federal program helps people with limited income and resources pay for healthcare. For information about Medicaid, call your State Medical Assistance office. You can find the number on the Medicare Website or call 1-800-MEDICARE. (1-800-633-4227); (TTY users call 1-866-653-4261) 24 hours a day, 7 days a week.
Programs of All-inclusive Care for the Elderly (PACE) - A combination of medical, social, and long-term care services available only in states that choose to offer it under Medicaid. Eligibility requirements vary from state to state. For details, contact your State Medical Assistance office.
Medicare Savings Programs - A program where your state Medicaid program helps you pay your Medicare premium and, in some cases, deductibles and coinsurance. Millions of people receive help through Medicare Savings Programs, which have different names in different states. For more information, call your State Medical Assistance office.
Supplemental Security Income (SSI) benefits - Help for people who are disabled, blind, or over age 65 AND have limited financial resources. SSI is NOT the same as Social Security benefits. For more information, call Social Security at 1-800-772-1213 (TTY: 1-800-325-0778) 24 hours a day, 7 days a week or contact your local Social Security office. You can also use the Benefits Eligibility Screening Tool (BEST) on the Social Security Website to find out if you're eligible.

How do I get extra help with prescription drug costs?

Some people qualify automatically because they participate in Medicare AND another program, such as Medicaid, Medicare Savings Programs, and Social Security Income (SSI) benefits. The government has already contacted these people about extra help, but they still need to choose a prescription drug plans.

Some need to apply to qualify because of limited income and resources. The Social Security Administration accepts applications by mail and on their Website.

Applying for extra help is NOT the same as joining a prescription drug plan. Whether you qualify for extra help or not, you must also enroll in a plan to get prescription drug coverage.

How much help will I receive?

Anyone who qualifies for extra help automatically can get prescription drug coverage with no monthly premium and no deductible. However, if the plan you choose costs more than a "standard" plan, you'll pay the monthly difference in cost.

Watch Healthcare Video: What is Medicare?