Medicaid and Other Low-Income Assistance

I’m having a hard time affording my Medicare Part D drug coverage. Are there any options for me?

You may want to find out if you qualify for extra assistance with your Part D plan premiums and cost sharing, if your income and assets are low enough. Through the Part D Low-Income Subsidy program, sometimes referred to as “Extra Help”, additional premium and cost-sharing assistance is available for Part D enrollees with low incomes (less than 150% of poverty, which was $19,320 for individuals/ $26,130 for married couples in 2021) and modest assets (less than $14,790 for individuals/$29,520 for couples in 2021). To find out whether you might qualify for Extra Help, you can contact the State Health Insurance Assistance Program (SHIP) in your state, the State Medical Assistance Office (Medicaid), or the Social Security Administration. You can apply for Extra Help at any time. There’s no cost to apply for Extra Help, so you should apply even if you’re not sure if you qualify.

If you apply and qualify for Extra Help, you should check to make sure that the Part D plan you are enrolled in is available to you for zero premium (known as a “benchmark” plan). Only a subset of stand-alone Part D drug plans qualify as premium-free for enrollees receiving Extra Help in each area. All people receiving Extra Help can select any plan offered in their area, but if you are receiving Extra Help and you enroll in a non-benchmark plan, you must pay some portion of your chosen plan’s monthly premium. If you are not currently in a benchmark plan, you can switch plans when you become eligible for Extra Help. You can compare your plan options and enroll in a drug plan by going to the Medicare Plan Finder, a searchable tool on the Medicare.gov website, or by calling 1-800-MEDICARE (1-800-633-4227). You can also contact the State Health Insurance Assistance Program (SHIP) in your state. SHIPs offer local, personalized counseling and assistance to people with Medicare and their families. You can call 877-839-2675 to get the phone number for the SHIP in your state.

While we have made every effort to provide accurate information in these FAQs, people should contact the health insurance Marketplace or Medicaid agency in their state for guidance on their specific circumstances.

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