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Medicare Extra Help Program Income Limits

Medicare Extra Help Program Income Limits

When it comes to healthcare, it is sometimes difficult for seniors to pay for the medical care they need. Premiums are getting higher, and the potential for health problems is always there. 

Because of this, there is a program called “Extra Help,” which is designed to help cover the majority of your out-of-pocket cost of prescription medications. This program is also sometimes called Part D Low-Income Subsidy or LIS. To be eligible for this program, you must meet a number of criteria. If your monthly income is $1,843 or less each month, and your combined assets are low, you may qualify.

For couples, your combined monthly income must be $2,485 or below to qualify. The limit on your assets for an individual is a maximum of $16,660. For couples, you’re allowed amount for all combined assets is $33,240. You can get extra help on your premiums, but bear in mind that the cost of premiums will depend upon your income. These guidelines only apply if you are on Medicare alone, and not a supplemental policy.  

The Social Security Administration (SSA) “automatically” takes $20 from your income that you did not earn. This typically comes from money you make in retirement. Your collective income and assets can be higher than eligibility limits, but you may also still qualify for Extra Help. This is because you cannot count “certain assets.” The $20 that is deducted may not be counted as income, either.

However, there are cases where you are automatically eligible for Extra Help. You are automatically qualified for Extra Help if you are enrolled in Medicaid, a Medicare Savings Program (MSP), or if you receive Supplemental Security Income or SSI. You qualify, even if you do not meet the eligibility requirements of Extra Help.

If you do qualify, the Centers for Medicare & Medicaid Services (CMS) will send you a purple notice informing you that you qualify for Extra Help and that there is no need to apply for it. The extent of help you receive will ultimately depend upon your assets and income. Your assets and income will also determine whether you are eligible for full or partial Extra Help. 

Both of these offer prescription drug coverages. However, to get this financial help, you need to make sure your drugs are covered by your plan. According to Mike Causey, Commissioner of the North Carolina Department of Insurance, those with few resources and limited income can benefit greatly from the Extra Help program.

Single individuals with an annual income lower than $21,876 usually qualify. These individuals typically have less than $16,660 in combined assets. Anything above this may result in disqualification. Receiving Extra Help through Medicare Part D provides a number of benefits to the aging population. Extra Help through Medicare Part D waves the Medicare Part D late enrollment penalty.

Additionally, it lowers your out-of-pocket cost for prescription medications. It removes monthly premiums for Medicare Part D, making your annual deductible free. However, there is an income limit on the Extra Help Program. The income limit for a single individual is $20,625. For married couples who live together, the annual income limit is $27,705.   

Keep in mind that other income assistance, such as food stamps, home energy assistance, and assistance with housing, will not have a negative effect on you. Even if you feel that your income is above the limits to qualify, you should still apply. You might still be eligible under certain conditions. 

You may be eligible if you make money by working or if you “provide financial support” to family members who live in the same dwelling as you. You may also qualify if you live in Hawaii or Alaska. To qualify, your resources need to be $15,510 or below for a single individual. 

Married couples must have burial insurance. If you do not have burial insurance, the financial limit on your assets is $14,010 for a single person and $27,950 for a married couple who live together. To receive Extra Help, be advised that your combined resource limit with burial expenses must equal $9,900 for individuals and $15,000 for a couple who are married and seeking Extra Help benefits.

It also helps to know what counts as resources. According to experts, money in bank accounts, real estate, stocks, and bonds all count as resources. Individual Retirement Accounts (IRAs), cash, and mutual funds all count as resources as well. 

It also helps to know what does not count as a resource. Your residence, car, interest on burial expenses, car, and personal belongings do not count as resources. 

There are different levels of Extra Help. According to Medicare, a single person’s resource limit should not exceed $8,400. If your income and total assets equal more than the maximum amounts, do not be discouraged. You may still qualify for partial extra help. However, the amount you receive in assistance will be dependent upon your total resources and income.

You can mail an Extra Help qualification letter to your “Medicare Part D program.” This helps Medicare understand the level of Extra Help you may qualify for. Extra Help is especially beneficial for seniors who are on a fixed income, because it covers prescription costs that may otherwise be out of reach for them.

The Extra Help program will cover all or some of your Part D expenses. You can see if you are eligible for this program by taking an assessment online. The Extra Help Program will also pay for a number of costs, including deductibles, copays, and Medicare Part D premiums. According to the Social Security Administration, the yearly value of Extra Help is $3,500 per person.  

You can file an application by paper form or online. Applications are available in English and Spanish. However, an electronic signature is required on the application if you apply online. You can request that the Social Security Administration send a paper application by mail, if necessary. 

A decision letter will be sent to you and will inform you of your eligibility. You typically receive this notice roughly three weeks after you submit your application. Once you are found eligible, you will get and receive LIS for the rest of the year, at minimum.

Under the Special Benefits program, you are also eligible for special enrollment periods. With this, you have the ability to change plans once during each quarterly enrollment period, without an enrollment penalty. You can also change plans during the annual enrollment period. However, bear in mind that there are specific requirements to qualify for benefits. 

What benefits does Full Coverage provide? 

According to the National Council on Aging, the average person on Medicare pays a minimum of $500 on prescription medications each year. Full Help covers individuals with low incomes and limited resources. Because the plan premium and deductible are waived, low-income seniors have access to their medications, while saving some of the money they have. 

Those who receive Full Extra Help typically pay between $1.45 to $4.30 for generic medications and $4.15 to $10.35 for their brand name counterparts. To qualify for free premiums, you will need to enroll in a benchmark plan. 

What does Partial Coverage provide? According to experts, partial coverage assists with medical costs for individuals in a slightly higher income bracket. With this plan, the premium is waived or adjusted, depending upon your income. Prescription deductibles with this plan are typically $104. Copays of generic medications under the partial plan are roughly $4.15. Under this plan, seniors pay $10.35 for brand name drugs.

Because Extra Help works in conjunction with social security assistance plans, individuals enrolled in these plans do not need to apply for Extra Assistance. You can use the program without getting a late enrollment penalty. 

To qualify for Extra Help, you must be eligible for Medicare Part A or Medicare Part B. Medicare Part A covers hospital care, while Medicare Part B acts as supplemental medical insurance, or both of these. You must also live in one of the 50 states in the United States or the District of Columbia (DC.)

Your collective income with you and your spouse must be less than 150 percent of the federal poverty level. This can also be dependent upon the size of your household. There are income limits. Federal poverty level guidelines are adjusted each year. These guidelines are designed to determine who is eligible for Extra Help services.

Bear in mind that poverty levels are different in Hawaii and Alaska than they are in the rest of the states. Poverty levels in Hawaii and Alaska are slightly higher, and as a result, different from other territories. The size of your family can also impact your eligibility. If your family size gets bigger, your benefits may be different. 

If an individual lives alone without family members, one’s income eligibility is based upon the benefit limit for someone who lives alone. If you live with other relatives for support, your benefit will be for that of a single person. Those who live with non-relatives can get policies for two individuals. 

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Table of Contents


  • Best overall Medicare supplement for new enrollees: Plan G.
  • Best overall Medicare supplement before 2020: Plan F.
  • Best low cost Medicare supplement: Plan K.
  • Best alternative to Plan G Medicare supplement: Plan N.

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Medicare Supplement policies are private health insurance designed to cover gaps in Original Medicare. They are also known as Medigap plans. These take care of costs such as copays, coinsurance, and deductibles which can become expensive if you need regular care from a doctor or hospital. If you need medical care while traveling outside the U.S., you can buy Medigap policies to help cover those costs. As a supplement to Original Medicare, you’re required to have Part A and Part B before you canget a Medigap policy. This way, Medicare is responsible for the Medicare-approved costs of the covered care, and the remainder is covered by your Medigap plan.

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Optimal coverage comes with higher costs, making Plan F the most expensive Medigap plan. Plan F is known as “first-dollar coverage” and it takes care of everything provided during a doctor or hospital visit. Your only responsibility is for dental, vision, medications, and equipment, such as hearing aids.

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The Federal government ended the Plan F option for new enrollees last year to keep the healthcare system from being overused by patients who had their deductibles covered. The next best coverage after Plan F is Plan G.

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Medigap Plan G offers every advantage of Plan F except for the deductible, which you have to cover. Because it isn’t as comprehensive as Plan F, Plan G is more affordable.

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For people who don’t go to the doctor often, Plan K is worth considering. It is the most affordable because it provides just 50% of Medicare Part B coinsurance, the Part A deductible, blood, skilled nursing, and Part A hospice costs. For comparison, Plan G and others offer full coverage of these expenses, and more.

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It’s hard to argue against plans which cut your traditional Medicare costs. For most people, having the extra coverage these supplemental plans provide is common sense, unless they want the specific features of a Medicare Advantage plan.

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Most people would benefit from not having to pay out-of-pocket to stay healthy. Medicare supplement insurance or a Medicare Advantage plan offer vital savings now, but are indispensable should a catastrophic health issue occur.

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Of the 10 Medicare-approved Medigap plans, Plan G and Plan N are the most popular. Plan F is no longer available to new Medicare enrollees as of 2020, but it is still popular among people who bought this plan prior to 2020.

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  • Plan F$128–$342
  • Plan F (high deductible)$22–$88
  • Plan G$106–$325
  • Plan G (high deductible)$29–$58

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Before getting a Medicare supplement plan, you need to be enrolled in Medicare Part A (hospital insurance) and Part B (medical insurance). People with Medicare Advantage Plans who want to go back to Original Medicare can buy a Medigap policy prior to switching.

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The security of having lower or no out-of-pocket healthcare costs can offset the premiums you’ll have to pay for whichever Medigap plan you choose, which vary depending on the benefits offered.

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The national average cost for Medicare Supplement Plan F is $1,824 annually, which is $152/month; Medigap Plan G will cost you around $143 per month.

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Since Plan F was discontinued for new enrollees as of 2020, Plan G offers the most coverage for people 65 and older. It has a lower premium than Plan F and duplicates its benefits, except for the Part B deductible.

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It depends on your specific needs, but for most people a Medigap plan is very useful in supplementing the coverage of Medicare Part A and Part B. A Medicare Advantage plan is an affordable way to get healthcare coverage not offered by Original Medicare.

Historically, Plan F has been the most popular because it covers all the out-of-pocket costs Medicare does’t pay for. This includes the 15% extra charge billed by providers who do not take Medicare as full payment.

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Since January 1, 2006, no Medigap policy came with prescription drug coverage. You have two options to get covered, enrolling in either a Medicare Prescription Drug Plan (Part D) or a Medicare Advantage plan.

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