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Medicare Rx Extra Help Application

Welcome!

The Medicare Prescription Drug program (also known as Part D) gives you a choice of prescription plans that offer various types of coverage. It also offers Extra Help with prescription drug costs for people with Medicare who have limited incomes and resources. Depending on your income and resources, you may be able to get help paying for your monthly premiums, annual deductible, and the cost of medications covered by your plan, providing you an average value of $4,000 per year. However, to get this help, you must be enrolled in a Medicare Prescription Drug plan.

If you apply for and get the Extra Help and you have not yet enrolled in a Medicare Prescription Drug plan (Part D), you may temporarily get prescription drug coverage through Medicare’s Limited Income NET (LI NET) Program. This program was created by Centers for Medicaid and Medicare Services (CMS) to eliminate gaps in prescription drug coverage for low-income Medicare Beneficiaries. The LI NET program is temporary and can only help you for a short time (usually about 2 months). If after this time, you have not chosen a Part D plan, CMS will automatically enroll you into one. For more information about LI NET, go to: www.Humana.com/LINET or call (800) 783-1307.

You also may be able to get help from your State with other Medicare costs under the Medicare Savings Programs. By completing this online application for Extra Help, you will start the application process for a Medicare Savings Program. SSA will send information from your Extra Help application to your State, unless you tell SSA not to when you complete this form. Someone from your State will contact you to help you complete your Medicare Savings Program application.

How Can You Get The Extra Help?

To get Extra Help with Medicare prescription drug costs, you must complete and submit this application. The Social Security Administration (SSA) will review your application and send you a letter to let you know if you qualify for Extra Help. SSA will also send you information about the Medicare Prescription Drug Coverage and tell you what you should do next.

NOTE: To apply, you must live in one of the 50 States or the District of Columbia.

What Is This Application?

This is an application for Extra Help with Medicare prescription drug costs. It does not enroll you in a Medicare prescription drug plan. To get that coverage, you will have to enroll directly with an approved Medicare prescription drug plan. If you need information about Medicare Prescription Drug plans or how to enroll in a plan, call Medicare’s toll-free number 1-800-MEDICARE (1-800-633-4227) (TTY 1-877-486-2048) or visit www.medicare.gov.

Who Should Complete This Application For Extra Help With Costs under the Medicare Prescription Drug Coverage?

You should complete this online application for Extra Help if:

  • You have Medicare Part A (Hospital Insurance) and/or Medicare Part B (Supplementary Medical Insurance); and
  • You live in one of the 50 states or the District of Columbia; and
  • Your income is below $18,090 if you are not currently married or not living with your spouse, or $24,360 if you are currently married and living with your spouse; and
  • Your combined savings, investments, and real estate are not worth more than $13,820 if you are not currently married or not living with your spouse, or $27,600 if you are currently married and living with your spouse. (DO NOT include the home you live in, vehicles, personal possessions, life insurance, burial plots, irrevocable burial contracts or back payments from Social Security or SSI.)

If you have more than those amounts, you may not qualify for the Extra Help. However, you can still enroll in an approved Medicare prescription drug plan for coverage.

Who Should Not Complete This Application For Extra Help With The Medicare Prescription Drug Plan Costs?

You should not complete this online application if:

  • You receive Medicaid and have Medicare, or
  • Your State pays for your Medicare premiums (Medicare Savings Program), or
  • You receive Supplemental Security Income (SSI) payments and have Medicare.

If you are in one of the 3 groups above, you will automatically get the Extra Help and do not need to apply.

When Can You Submit Your Application?

This service is available during the following hours (Eastern Time):

Monday through Friday: 5:00 AM – 11:00 PM
Saturday: 5:00 AM – 9:00 PM
Sunday: 8:00 AM – 8:00 PM
Holidays: 5:00 AM – 9:00 PM

* Social Security accepts applications during certain hours. We recommend that you begin at least one hour before the latest time listed above to ensure your application will be processed.

If you need help completing this application, click here to find a local agency in your community, or call Social Security toll-free at 1-800-772-1213 (TTY 1-800-325-0778).

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