Extra Help Paying for Prescriptions
Getting Help Paying for Medicare Prescription Drugs
Some Medicare beneficiaries with limited income and resources can qualify for “Extra Help” to pay for their Medicare Part D (prescription drug) monthly premiums, annual deductibles, and co-payments. In addition, people who qualify for Extra Help will have no coverage gap and will not pay a late enrollment penalty.
To find our if you qualify you can:
- Visit https://www.ssa.gov/benefits/medicare/prescriptionhelp.html and click on the “Find Out if You Qualify” button,
- Call Social Security at 800-772-1213 (TTY: 800-325-0778) to apply over the phone,
- Call Medicare at 800-633-4227, 24 hours a day, seven days a week,
- Call your Indiana Medicare office
You’ll need to provide information about your income and your resources, including your savings, investments, IRAs and any real estate other than your home. If you’re married, you’ll also need to provide information for both you and your spouse. To qualify for Extra Help, your yearly income must be below $22,590 for an individual or $30,660 for a married couple. Your assets need to be below $15,720 per year for an individual and $31,360 for a married couple.
After you apply for Extra Help, your application is reviewed by the Social Security Administration. You’ll get a letter in the mail if you qualify for Extra Help.
What do I pay if I qualify for Extra Help?
What you pay for your MDwise Medicare monthly plan premium depends on the level of Extra Help you receive from Medicare. The table below shows what your total monthly plan premium* will be if you get Extra Help:
2024
|
Your Level of Extra Help
|
MDwise Medicare Inspire
|
MDwise Medicare Inspire Plus
|
MDwise Medicare Inspire Flex
|
|
100%
|
$0
|
$0
|
$6.70
|
*This amount does not include any Part B premium you may have to pay.
Best Available Evidence
If you qualify for Extra Help, but believe that you are paying the wrong copay amounts at your pharmacy, MDwise Medicare can assist you with getting the evidence of your correct copay amounts. If you already have the evidence, you can provide that to us. Call Member Services at 833-358-2140 (TTY: 711) if you have questions or for more information on how to send us your evidence.
You can visit the CMS website to learn more about the Best Available Evidence (BAE) policy.