You May Qualify for Assistance with Paying Prescription Drug Costs
Medicare prescription drug programs can help pay Part D premiums, deductibles and coinsurance
Reviewed by: Shikita Nunnery, Licensed Insurance Agent. Written by: Aaron Garcia.
Being able to afford prescription drugs is a common problem for America’s seniors.
Extra Help is a Low-Income Subsidy (LIS) that helps lower or eliminate Medicare Part DMedicare Prescription Drug Plan (Part D) is prescription drug coverage for people enrolled in Medicare. Part D is optional and is offered by private insurance companies. premiumsA premium is a fee you pay to your insurance company for a health plan coverage. This is usually a monthly cost. and deductiblesA deductible is the amount you pay out of pocket before your insurance company covers its portion of your medical bills. For example: If your deductible is $1,000, your insurance company will not cover any costs until you pay the first $1,000 yourself.. It also caps out-of-pocket prescription costs like copaysA copayment (copay) is the fixed amount you pay directly to your provider for medical services or prescription drugs covered in your plan. For example: If your plan includes a copayment of $20 for office visits, you'll pay $20 to your doctor whenever you have an appointment. and coinsuranceCoinsurance is the percentage of your medical costs that you pay after you meet your deductible. The remaining amount is paid by your insurance company. For example: If you have a $1,000 medical bill and your coinsurance is 20%, you'll pay $200. Your insurance company will cover the final $800..
State Pharmaceutical Assistance Programs (SPAP) can offer help but provides different services per state. Many states don’t participate in the program at all.
If you qualify for Extra Help but don’t have a Part D plan, the Limited Income NET can provide temporary drug coverage.
Are you an American senior struggling to afford your healthcare each month? Even with Medicare Prescription Drug Plan (Part D), prescription costs can be a burden to your monthly budget. Recent studies show that nearly nine in 10 seniors take a prescription drug, and 23% report difficulty affording their medications. 
Fortunately, there are programs designed to help.
Medical costs can add up quickly. If you need help with prescriptions, start by applying for the Medicare Extra Help program. This low-income subsidy (LIS) can help lower, and even eliminate, your Part D monthly premium and deductible. It also can help with your at-the-counter costs by capping your copayments and coinsurance when you pick up your medications.
In 2021, Extra Help recipients will pay no more than:
- $3.70 per generic drugs.
- $9.20 per name-brand drugs.
Some recipients may be eligible to pay $0 for their medications.
Made specifically to help with prescription costs only, the Medicare Part D LIS mainly considers income. In 2020, you were eligible if:
- Single and earning up to $19,140 in income with up to $14,160 in resources like money, stocks and bonds.
- You were married and made up to $25,860 and had up to $29,160 in resources. 
- You lived in one of the 50 states or Washington D.C.
- You are a Medicare and Part D beneficiary.
The Medicare Extra Help LIS is a popular choice for Americans looking for help paying for their Medicare prescription plans; roughly 30% of Part D enrollees receive Extra Help. 
How to apply for Extra Help
If you’re a Medicare and Part D beneficiary, live in the United States, and meet the income requirements, there are several ways to apply, including:
- Fill out an Extra Help application on the Social Security Administration website. 
- Call for Social Security Extra Help assistance: 1-800-772-1213.
Many people stop here when seeking out payment assistance, but there may be other resources available regardless of whether you qualify for the Extra Help LIS.
Medicare’s Limited Income Newly Eligible Transition program, also called the Limited Income NET, or LI NET, provides prescription access to seniors who have qualified for Medicare’s Extra Help LIS but not a Part D beneficiary. Enrolling in a Limited Income NET will give you two months of prescription coverage before you enroll in a Part D plan. If you don’t choose a program during that time, Social Security will enroll you. 
The Medicare Limited Income NET also provides retroactive coverage for enrollees that have dual-eligibility or Supplemental Security Income. In this case, your pharmacy coverage could span as far back as 36 months.  If you missed your Part D Initial Enrollment Period, this may eliminate your late enrollment penalty.
SPAPS are state-run programs that offer adults and seniors financial assistance with prescription costs. However, many states don’t participate in the prescription assistance program, so you’ll want to see what offerings are available in your state.  Some may offer copay assistance programs and other prescription drug assistance, while others pick up the costs that Part D doesn’t.
Can I apply for Extra Help with my Part B premiums, too?
No, the LIS is only for Part D. If you need help paying for Part B, see if you qualify for a Medicare Savings Program in your area.
Does Medigap cover prescription drugs?
No. Starting in 2006, Medicare Supplement Insurance (Medigap) plans cannot cover prescription drug costs. If you’ve had a Medigap plan with prescription coverage before 2006, your plan may still cover prescription drugs through a grandfather clause. 
Does anyone automatically qualify for Extra Help?
Yes. Because the Extra Help LIS is income-based, you’ll automatically qualify if any of the following apply to you:
- You receive full Medicaid Coverage.
- You’re enrolled in your state’s Medicare Savings Program to get help paying your Medicare Part B costs.
- You receive Supplemental Security Income (SSI) benefits.
How long does my Extra Help eligibility last?
Because incomes and personal situations change, your eligibility may change year-to-year. If so, Medicare will send you a letter detailing any concerns. 
- If you no longer automatically qualify and need to reapply: You’ll receive a grey letter by the end of September to let you know.
- If CMS knows that copayment costs will increase or decrease the next year, you’ll receive an orange letter detailing the new amounts. This should arrive in October.
- If you don’t receive a letter: Your Extra Help levels are not scheduled to change. Beware: If you haven’t received a letter by the end of October, we suggest you call your Social Security office to verify in case your notice was lost in the mail.