Medicare Extra Help

What is Medicare Extra Help?

Medicare gives "extra help" to pay prescription drug costs for people who have limited income and resources. Resources are your savings and stocks, but not assets such as your home or car. If you qualify, you will get help paying for any Medicare drug plan's monthly premium, yearly deductible and drug copays. This extra help will count toward your out-of-pocket costs.

How do I qualify for Extra Help?

Here are some ways you can qualify for Extra Help:

• If you get full Medicaid benefits, you are automatically eligible for Extra Help—there is no need to apply separately. Medicare will mail you a letter with information about Extra Help when you qualify.

• If you get any help from Medicaid paying your Medicare premiums or receive Supplemental Security Income, you will automatically get Extra Help and do not need to apply separately. However, you will need to enroll in a Medicare prescription drug plan.

• If you have limited income and resources and don’t get help from Medicaid, you can apply for Extra Help and enroll in a Medicare drug plan¹. Call 1-800-MEDICARE ( 1-800-633-4227), 24/7 (except some federal holidays) (TTY 1-877-486-2048).

How do I prove I’m eligible for Extra Help?

The Centers for Medicare & Medicaid Services started the Best Available Evidence policy to deal with Extra Help eligibility. BAE makes sure that people getting Extra Help aren’t charged too much or have higher copayments than they're supposed to.

According to CMS, all plan sponsors, like HealthSpring, must accept BAE sent by someone applying for Extra Help if they are eligible, even if Medicare records don’t show it. Once you’ve sent BAE to HealthSpring, we will ask CMS to change your status in their system.

Some acceptable forms of BAE are:

• A copy of your Medicaid card (if you have one)
• A copy of a state document that shows you have Medicaid
• A print-out from a state electronic enrollment file or from your state's Medicaid systems that shows you have Medicaid
• A full-page screenshot from the State's Medicaid systems showing Medicaid status
• Any other document from your state that shows you have Medicaid
• A document from your state that shows you have Medicaid and are getting home- and community-based services
• Social Security Administration Award Letter
• An “Application Filed by Deemed Eligible” (SSA publication HI 03094.605) confirming that the beneficiary is “automatically eligible for extra help with Medicare prescription drug plan costs”

See a sample notice of the Application filed

Go to CMS.gov to learn more about BAE Policy

Medicare and Social Security Info:

• 1-800-MEDICARE (1-800-633-4227), 24/7 (except some federal holidays) (TTY 1-877-486-2048)
• The Social Security Office at 1-800-772-1213, 7 a.m. – 7 p.m., Monday – Friday (TTY users should call 1-800-325-0778)
• Your local State Medicaid Office