How do i check the status of my extra help

If you do not have Medicaid, Supplemental Security Income (SSI), or a Medicare Savings Program (MSP), you can apply for the Extra Help program through the Social Security Administration (SSA) using either the agency’s print or online application. (If you have Medicaid, SSI, or an MSP, you should be automatically enrolled in Extra Help.) To apply online, visit www.ssa.gov. Depending on processes in your state, this application can also serve to screen you for a Medicare Savings Program, which helps pay your Medicare costs. Be sure to complete the entire application and provide accurate information so you get all the benefits for which you qualify.

Remember, Extra Help reduces your prescription drug costs only for drugs covered by your Part D plan. If you do not have a Part D plan but are eligible for Extra Help, you can use the Special Enrollment Period (SEP) to enroll in Part D drug coverage.

If your application for Extra Help is denied or you disagree with the award (for instance, you think that you should receive full Extra Help but you were only awarded partial Extra Help), you can appeal to SSA. Your will have the opportunity to submit information about why you qualify when you appeal.

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Extra Help basics

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Options for those whose Extra Help application is denied, or whose benefit is less than expected

Remember that Extra Help is not a replacement for Part D or a plan on its own: You must still have a Part D plan to receive Medicare prescription drug coverage and Extra Help assistance. If you do not choose a plan, you will in most cases be automatically enrolled in one.

Making an Extra Help decision when you have other forms of prescription drug coverage

If you are eligible for Extra Help and already have other creditable drug coverage, you should evaluate your costs and coverage when deciding whether to enroll in Part D and Extra Help or to keep your current drug coverage. Be sure to ask your former employer or union if you can get a Part D plan without losing the retiree benefits you want to keep, and check if disenrolling from retiree drug coverage makes you ineligible for other retiree health benefits. If you cannot have Part D and your retiree benefits, or if keeping both is not cost-effective, think carefully about whether you should get a Part D plan, especially if your retiree plan also covers your spouse or dependents. If you later want Part D, you will have a two-month SEP after you lose creditable coverage.

Finally, those with Medicaid and certain kinds of employer, union, or retiree drug coverage may in some cases not be enrolled in Extra Help or can ask not to be. Contact your local Medicaid office to learn how to decline Part D without losing your Medicaid coverage. If you later want Part D, you can enroll at any time without penalty if you are still enrolled in Medicaid or eligible for Extra Help.

Is your client eligible for the Medicare Extra Help program? You could play a huge role in getting them financial assistance with prescription drug coverage and medications. What are the income limits for Part D Extra Help, and are there Medicare Extra Help look-up tools?

If you’ll be discussing prescription drug coverage during an appointment, it’s important that you verify whether your client qualifies for the Extra Help with Medicare. This federal program could mean the difference between your client having affordable access to important medications in their doctor’s treatment plan or not!

Note: If a client does not meet the Medicare Extra Help income limits, that does not automatically disqualify them from state assistance programs! The eligibility guidelines for these programs can differ, so be sure to check on a client’s eligibility for both types of assistance.

What Is the Medicare Extra Help Program?

The Extra Help program is a joint effort by the Centers for Medicare & Medicaid Services (CMS) and the Social Security Administration (SSA) to provide financial assistance to those who need it to pay for their Medicare prescription drug coverage and prescription drugs. This program is also called the “Medicare Low-Income Subsidy program.”

How does the LIS/Extra Help program work?

Enrollees in this program usually DO NOT have to pay:

• Premiums for their prescription drug coverage
• Deductibles for their prescription drug coverage (unless they only receive a partial subsidy instead of the full one)
• The Part D late enrollment penalty
• Full copays or coinsurance
• More than $9.85 for the prescription drugs their plan covers (in 2022)

Program members also get a quarterly Special Enrollment Period to join or switch Medicare Part D plans. Over the course of a year, someone on Medicare who is receiving Extra Help could potentially save about $5,100!

Who Automatically Qualifies for Part D Extra Help?

Some people automatically qualify for the LIS, meaning they don’t need to complete the Extra Help application. Here are the individuals who should automatically receive Extra Help:

• Individuals who are eligible for both Medicare and Medicaid (dual-eligibles)
• People who receive Supplemental Security Income (SSI)
• Those who qualify for a Medicare Savings Program

Looking Up or Verifying Medicare Extra Help Status

It’s unlikely your clients will know, or recognize, if they qualify for or receive the LIS/Extra Help, unless they’ve applied for it, and even then, their status may have since changed. During appointments, agents should confirm whether their client qualifies for the LIS/Extra Help before enrolling them in a prescription drug plan. By doing this, you’ll be acting in your clients’ best interests, helping them afford the medications they need and even save money on their prescriptions. What better way to show your clients that you’re the right agent to get the job done?

Extra Help/LIS Income Limits & Eligibility Requirements

To qualify for the LIS or Extra Help, an individual must:

• Have Medicare Part A and/or Part B
• Live in one of the 50 United States or the District of Columbia
• Have less than $30,950 (married) or $15,510 (single) total in savings, investments, and real estate net worth (exceptions may apply, limits may change from year to year)

One’s income will affect how much of the LIS they receive — the full subsidy or only part of it.

Extra Help/LIS Look-Up Tools and Methods

You’re likely more technology savvy than your clients. It will likely be easier for you to just look up their LIS status for them, or with them, rather than trying to explain to your clients how to do it themselves and waiting for an answer. If you’re ready to verify a client’s LIS status, you can do this with CMS or the carrier, online or over the phone.

Four ways to verify a client’s Medicare Extra Help status:

1. Use an LIS look-up tool in a carrier’s portal (if the carrier has one).
2. Call the carrier and ask to confirm your client’s LIS eligibility.
3. Call 1-800-Medicare (1-800-633-4227) and ask to confirm your client’s LIS eligibility.
4. Have your client create and/or log in to their MyMedicare.gov account and check if they qualify for the LIS.

Note: These tools are available pre-enrollment for agents to check eligibility prior to enrollment.

Will My Client Be Notified If Their Extra Help Status Changes?

If your client’s Extra Help status changes, they should receive a notification from CMS or the SSA via mail. The color of the notice will vary, depending on the purpose the notice serves.

Medicare Extra Help Status Cheat Sheet

Helping Your Client Apply for Extra Help with Medicare

Anyone who does not automatically get the LIS, should complete the Medicare Extra Help application if there’s a chance they are eligible for it. If you think your client may qualify for this program, you can help them apply for it via the Social Security Administration’s website. Clients can also call or visit their local Social Security office to apply. Individuals who need further assistance can contact their State Health Insurance Assistance Program (SHIP).

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Did you know that a 2010 study found that more than 2.3 million Medicare beneficiaries who weren’t enrolled in the government’s Medicare Extra Help program may have qualified for it? Don’t let your clients be a part of this statistic. Help them take advantage of the financial assistance they’re entitled to, but may not know about, starting today!

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