Low income individuals with limited resources may be eligible for help with prescription drug costs. Under a Medicare program called Extra Help, qualifying individuals can obtain financial help to pay for their drugs. You can qualify if your income is below certain limits. Those limits change annually so it is advisable to check with your local social security administration to obtain current income limits.
If you join a Medicare drug plan, and you also qualify for Extra Help, you will receive help with paying your plan’s premiums. A late enrollment penalty cannot be assessed upon you regardless of when you join a Medicare prescription drug plan. You may switch between plans at any time until you find the plan that works for you. You will also, not have a coverage gap, or donut hole.
Individuals who are currently on Medicaid, get help with their Medicare Part B premium, or are receiving Supplemental Security Income (SSI) benefits, automatically qualify for Extra Help.
If Medicare mails you a purple letter, you automatically qualify for Extra Help. There is no need to apply, but you should keep the letter for your records. This is how Medicare informs you that you are automatically qualified. To use the Extra Help, you must join a Medicare drug plan if you are not already enrolled in one. If you automatically qualify, and you fail to enroll in a Medicare drug plan, Medicare might enroll you in one in order that you may be able to utilize your Extra Help benefits. If Medicare ends up enrolling you, you will receive a green or yellow letter in the mail. The purpose of this letter is to inform you of your plan and the effective date of your benefits. It is important that you check with the plan to make sure that the drugs that you need are covered. Not all plans cover the same drugs, and NO plan covers ALL drugs. Also important are the pharmacies that you can go to for the filling of your prescriptions.
Individuals who have Medicaid and live in nursing homes, get home and community-based services, or live in certain other institutions do not pay anything for covered prescription drugs.
If you receive one of the letters mentioned above, and you don’t want to be in a Medicare drug plan, you may contact the plan listed in your letter. You can also call 1-800-MEDICARE. Wherever you call, inform them that you want to opt out of a Medicare drug plan and they will cancel your plan. If you have creditable prescription drug coverage through your employer or union, or if you continue to qualify for Extra Help you will not have to pay a penalty if you later join a Medicare drug plan.
Individuals who have drug coverage through an employer or union, and join a Medicare drug plan, could lose their employer or union coverage. Before you join a Medicare drug plan, you should contact you employer’s benefits administrator.
If you do not receive a purple letter shortly after first becoming eligible for Medicare Parts A and B, it means that you did not qualify automatically. In this case, you can apply at any time by calling Medicare or visiting your local social security office.