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Extra Help with a Medicare Prescription Drug Plan

What is Medicare Extra Help?

Anyone who is enrolled in a Medicare plan, has the opportunity to receive Medicare Prescription Drug coverage. Individuals who have limited assets and income may be eligible for Extra Help (a Low Income Subsidy) when it comes to the cost of a Prescription Drug plan.

To find out if you qualify for Extra Help for Medicare, the Social Security Administration will need to know your income, assets, and savings. They also need information on whether or not you are married and living with your spouse. Furthermore, you must fill out a specific application (Form SSA-1020). It can be found on www.socialsecurity.gov. In addition, some individuals automatically receive Extra Help without even applying through Social Security.

Extra Help with a Medicare Prescription Drug Plan

What Paperwork Do You Need for the Medicare Extra Help Application?

  • Investment statements
  • Tax returns and Life insurance policies
  • Payroll slips and Pension letters
  • Recent balance statements from banks, credit unions etc.

Where Do You Apply for Medicare Extra Help?

You can physically visit your local Social Security office, or you can call Social Security 1-800-772-1213. You may also apply online by visiting www.socialsecurity.gov.

Who is Eligible for Medicare Extra Help?

  1. People who have a Medicare Savings program (partial dual eligibility)
  2. People who receive Supplemental Security Income benefits but do not receive Medicaid
  3. People who are eligible to receive Medicaid and Medicare (full dual eligibility)

What is the Best Available Evidence Policy? (BAE)

The Centers for Medicare and Medicaid Services (CMS) created the Best Available Evidence Policy in 2006. The policy was made to help sponsors establish how much cost-sharing for low-income beneficiaries was available if there was evidence that the beneficiary’s Prescription Drug plan was not accurate.

How to Use the Best Available Evidence Policy? (BAE)

  • When your Low Income Subsidy (LIS) information for your Medicare Prescription Drug Plan is not up-to-date.
  • If your Medicare Prescription Drug Plan is incorrect, you can use the BAE policy and show that you qualify for Extra Help. For instance, you can utilize your award letter from Social Security, your Medicaid card, or anything else that proves you are eligible for Extra Help.