Roxanne Anderson is the Editor/Lead Copywriter at Ritter Insurance Marketing. She’s been writing and editing for the Ritter blog since its inception in 2016! Shortly before she started at Ritter, Roxanne earned a Bachelor of Arts degree in English with a professional writing concentration from Elizabethtown College. Outside of work, she loves spending time with her husband, two sons, and daughter vacationing at the beach, and playing volleyball or Catan!
& Cassady Potts Cassady Potts | Copywriter
Cassady Potts joined Ritter Insurance Marketing as a copywriter in 2021. She attended The Pennsylvania State University, where she earned a bachelor's degree in English and journalism. When she's not at work, Cassady is cuddling up with her two cats, going to concerts, and spending time with friends.
• November 1, 2023Is your client eligible for the Medicare Extra Help program? You could play a huge role in getting them financial assistance with prescription drug coverage and medications. What are the income limits for Part D Extra Help, and are there Medicare Extra Help look-up tools?
If you’ll be discussing prescription drug coverage during an appointment, it’s important that you verify whether your client qualifies for the Extra Help with Medicare. This federal program could mean the difference between your client having affordable access to important medications in their doctor’s treatment plan or not!
Note: If a client does not meet the Medicare Extra Help income limits, that does not automatically disqualify them from state assistance programs! The eligibility guidelines for these programs can differ, so be sure to check on a client’s eligibility for both types of assistance.
The Extra Help program is a joint effort by the Centers for Medicare & Medicaid Services (CMS) and the Social Security Administration (SSA) to provide financial assistance to those who need it to pay for their Medicare prescription drug coverage and prescription drugs. This program is also called the ”Medicare Low-Income Subsidy program.”
Enrollees in this program usually DO NOT have to pay:
Once total drug costs reach $8,000, your client pays $0 for each covered drug.
If your client also gets full Medicaid coverage and are in the Qualified Medicare Beneficiary (QMB) program, they won’t pay more than $4.60 for each covered drug.
Program members also get a quarterly Special Enrollment Period to join or switch Medicare Part D plans. Over the course of a year, someone on Medicare who is receiving Extra Help could potentially save about $5,100!
Some people automatically qualify for the LIS, meaning they don’t need to complete the Extra Help application. Here are the individuals who should automatically receive Extra Help:
Starting in 2024, beneficiaries eligible for partial extra help will automatically receive full extra help.
It’s unlikely your clients will know, or recognize, if they qualify for or receive the LIS/Extra Help, unless they’ve applied for it, and even then, their status may have since changed. During appointments, agents should confirm whether their client qualifies for the LIS/Extra Help before enrolling them in a prescription drug plan. By doing this, you’ll be acting in your clients’ best interests, helping them afford the medications they need and even save money on their prescriptions. What better way to show your clients that you’re the right agent to get the job done?
To qualify for the LIS or Extra Help, an individual must:
You’re likely more technology savvy than your clients. It will likely be easier for you to just look up their LIS status for them, or with them, rather than trying to explain to your clients how to do it themselves and waiting for an answer. If you’re ready to verify a client’s LIS status, you can do this with CMS or the carrier, online or over the phone.
Four ways to verify a client’s Medicare Extra Help status:
Note: These tools are available pre-enrollment for agents to check eligibility prior to enrollment.
If your client’s Extra Help status changes, they should receive a notification from CMS or the SSA via mail. The color of the notice will vary, depending on the purpose the notice serves.
| Notice | Color of Notice | Who Sends It? | Recipient | Need to Apply or Reapply? |
|---|---|---|---|---|
| Automatically Qualify for Extra Help | Purple | CMS | Has both Medicare and Medicaid, is in a Medicare Savings Program or gets SSI | No |
| Automatically Qualify for Extra Help Because You’ll Be Auto-Enrolled in a PDP | Green or Yellow | CMS | Qualifies for Medicare and Medicaid and currently gets benefits through Original Medicare | No |
| Social Security LIS & MSP Outreach Notice | N/A | Social Security | May qualify for Extra Help | Yes |
| Copay Amount Changing | Orange | CMS | Automatically qualifies for Extra Help but has a copayment changing | No |
| No Longer Automatically Qualify for Extra Help | Grey | CMS | Used to get Extra Help automatically but no longer automatically qualifies | Yes |
Anyone who does not automatically get the LIS, should complete the Medicare Extra Help application if there’s a chance they are eligible for it. If you think your client may qualify for this program, you can help them apply for it via the Social Security Administration’s website. Clients can also call or visit their local Social Security office to apply. Individuals who need further assistance can contact their State Health Insurance Assistance Program (SHIP).
Did you know that a 2010 study found that more than 2.3 million Medicare beneficiaries who weren’t enrolled in the government’s Medicare Extra Help program may have qualified for it? Don’t let your clients be a part of this statistic. Help them take advantage of the financial assistance they’re entitled to, but may not know about, starting today!
Editor’s Note: This post has been updated to include information relevant for 2022.
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