People With Medicare

Do I qualify for extra help with costs?

There are different levels of extra help available, depending on your income and assets. People with a lower income and fewer assets get more help with their Medicare drug plan costs.

Level 1  You may qualify for extra help if
your yearly income is less than this amount-- AND the amount of resources you own does not exceed
$10,210 for an individual or $13,690 for a couple $7,620 for an individual or $12,190 for a couple
Level 2  You may qualify for extra help if
your yearly income is less than this amount-- AND the amount of resources you own does not exceed
$13,783.50 for an individual or $18,481.50 for a couple $7,620 for an individual or $12,190 for a couple
Level 3  You may qualify for extra help if
your yearly income is less than this amount-- AND the amount of resources you own does not exceed
$15,315 for an individual or $20,535 for a couple $11,710 for an individual or $23,410 for a couple

The resource amount includes $1,500 in savings that you can use as a burial fund. Couples can have $3,000 for the burial savings.

You may not qualify for extra help with costs if your income or assets are over these limits.

There are special circumstances that let you have a higher income or more resources and still qualify. For example, if you work, if you support other family members who live with you, or if you live in Hawaii or Alaska, you may qualify even if your income is higher than these limits. The “BenefitsCheckUp” questionnaire can help you find out if you are likely to qualify for extra help.

How much support would I get from the extra help?

Level 1
Premium: None
Deductible: None
For drugs, you would pay: $1.05 co-pay for generic drugs on your plan’s drug list
$3.10 co-pay for brand name drugs on your plan’s drug list
  If your total drug costs go over $5,726.25 for the year, you pay no co-pay for drugs on your plan’s drug list
Level 2
Premium: None
Deductible: None
For drugs, you would pay: $2.25 co-pay for generic drugs on your plan’s drug list
$5.60 co-pay for brand name drugs on your plan’s drug list
  If your total drug costs go over
$5,726.25 for the year, you pay no co-pay for drugs on your plan’s drug list
Level 3
Premium: Sliding Scale
Deductible: $56
For drugs, you would pay: 15% up to $5,726.25
  If your total drug costs go over $5,726.25 for the year, you pay:
$2.25 co-pay generic drugs on your plan’s drug list
$5.60 co-pay for brand name drugs on your plan’s drug list

Remember that everyone with Medicare qualifies for the Medicare Prescription Drug Coverage. If you qualify for extra help or not, you need to join a Medicare drug plan to get Medicare Prescription Drug Coverage.

NEXT: What information do I need to apply for extra help?