Thomas* visited with his doctor for a follow-up after a series of health issues. His doctor prescribed a blood thinner for him to take daily. When Thomas went to his local pharmacy to pick up the prescription, he was shocked to hear that the cost of this medication was over $300 with his Part D plan. Thomas has a limited income but prior to his current health issues, he’d had sufficient savings to pay for all his needs. After this series of health issues, his savings had been depleted and he felt that he could not afford this prescription. He left the pharmacy without the prescription, resigned that he would not be able to take this life-saving prescription.
Unfortunately, Thomas’ story is not unique. Almost 25% of older adults struggle to afford their prescriptions. In Thomas’ case, he was able to get some help! Thomas learned about the Low-Income Subsidy program from his local SHIP counselor. Because of his limited income and savings, Thomas was eligible for the Low-Income Subsidy. The SHIP counselor helped him to apply and within a couple of weeks, he was approved for benefits. He was able to get his Part D plan premium paid and had only a $9.85 copay for his blood thinner.
The Medicare Extra Help Program, sometimes called the Low-Income Subsidy or LIS, is a program designed to help people with low income and resources pay for prescription drug costs. It helps pay for Part D plan premiums and lowers copays for people who qualify. Depending on the Part D plan you choose, the Extra Help program may cover 100% of the monthly plan premium. For 2022, the copays are no more than $3.95 for generic and $9.85 for brand name drugs. Additionally, when you qualify for the Extra Help program, you can change your Part D plan up to once per quarter.
The Extra help program can be extremely beneficial for people who regularly find themselves in the Part D Coverage Gap. With a regular Part D plan, you may have times during the year where you are responsible for 25% of the total cost of your prescription. If you qualify for this benefit, you pay the same copays all year long, regardless of whether you would be in the coverage gap or not.
If you have income of less than $19320 for an individual ($26130 for a married couple) and assets of less than $15510 ($30950 for a married couple), you probably qualify for this benefit. Keep in mind that some resources do not count toward the asset limit. Exempt assets include a home, vehicles and personal possessions. In addition, some kinds of income do not count toward eligibility. Income from public assistance benefits (like SNAP, HEAT or housing assistance) do not count, nor do payments from friends or family to help cover your household expenses.
There are multiple ways to apply for the Extra Help benefit. You can apply online at https://www.ssa.gov/benefits/medicare/prescriptionhelp.html You can also apply over the phone by calling the Social Security Administration at 1-800-772-1213. Also, once a year, Social Security will send out applications in the mail for people who may qualify. If you receive an application in the mail, simply fill out the application and return it to the Social Security Administration. But you may qualify even if you don’t receive an application in the mail.
The Area Agency on Aging – Five County can help you apply for this program if you think you may qualify. For more information or help applying, contact the SHIP program at (435)673-3548.
*Name changed to protect privacy.
Amy Brinkerhoff has worked for the Five County Association of Governments for over ten years. She graduated from Brigham Young University with a degree in Sociology. Amy has been a SHIP counselor since her first week at Five County and now serves as Coordinator for the SHIP and SMP programs, where she offers one-on-one Medicare Counseling and teaches classes on Medicare topics and Fraud prevention.