Medicare Plans - Help

Learn About How to Get Extra Help

Extra Help for your prescription drug costs

Medicare eligible beneficiaries with limited income and resources may qualify to get extra help for their prescription drug costs.  If you qualify, Medicare could help you pay for your monthly prescription drug premium, annual deductible, copayments and coinsurance.  The amount of extra help varies based on your income and resources.

Millions of people receive Extra Help for their prescription drug costs, so why not find out if you qualify?  Even if you’re not sure that you qualify, go ahead and apply.  There’s no risk and no cost, so you might as well try!

The Social Security Administration is accepting applications by mail and on their Website.

How do I apply?

The simple, four-page application is available at your local Social Security Administration office.  Call 1-800-772-1213, 7 a.m. to 7 p.m., Monday through Friday. TTY 1-800-325-0778.  You can also apply online for extra help by visiting www.ssa.gov for “Extra Help With Medicare Prescription Drug Plan Costs”.  You will need to answer some questions about your assets and sources of income.  The application is secured, which means only you and the Social Security Administration can see the information you provide.  You should review your application before you submit and print your receipt. 

Remember, applying for extra help is NOT the same as joining a prescription drug plan.  Whether you qualify for extra help or not, you must also enroll in a plan to get prescription drug coverage.

More about Extra Help (LIS)

Extra Help is also known as the Low Income Subsidy (LIS).  The LIS program is for Medicare beneficiaries with limited income and resources to help them pay for their prescription drug costs including monthly premiums, annual deductibles, and copayments.  Many Medicare beneficiaries are eligible for these savings and don’t know it.  Those who qualify will enjoy free drug coverage or reduced costs on their Part D benefits. 

For more information about Extra Help, contact your local Social Security office or call 1-800-Medicare (1-800-633-4227) 24 hours a day, seven days a week.  TTY 1-877-486-2048.  You can also contact your state Medicaid office through the Department of Children and Families at 1-866-762-2237.  TTY 1-800-955-8771 or 1-800-955-8770.  Visit www.myflorida.com/accessflorida on the web. 

Some Medicare beneficiaries qualify automatically for Extra Help because they also have other programs such as Medicaid, Medicare Savings Programs, and Social Security Income (SSI) benefits.  While others need to apply.

Who qualifies automatically for Extra Help?

You will automatically qualify for Extra Help if you have Medicare and also become eligible for certain Federal, State or Local programs that help with your medical costs depending on your income, resources, and other factors.  These programs include the following:

 

  • Medicaid – This joint State and Federal program helps Medicare beneficiaries with limited income and resources pay for their healthcare costs.  For information about Medicaid, call your State Medical Assistance office.  You can find the number on the Medicare Website http://www.Medicare.gov/or call 1-800-Medicare (1-800-633-4227) 24 hours a day, seven days a week.  TTY 1-866-653-4261.

 

  • Programs of All-inclusive Care for the Elderly (PACE) – A combination of medical, social, and long-term care services available only in states that choose to offer it under Medicaid.  Eligibility requirements vary from state to state.  For details, contact your State Medical Assistance office.

 

  • Medicare Savings Programs – These programs are offered under your state Medicaid program and help you pay your Medicare premium and, in some cases, deductibles and coinsurance.  Millions of Medicare beneficiaries receive help through the Medicare Savings Programs, which have different names in different states.  For more information, call your State Medical Assistance office.

 

  • Supplemental Security Income (SSI) benefits – Help for people who are disabled, blind, or over age 65 and have limited financial resources.  SSI is NOT the same as Social Security benefits.  You can find out if you are eligible by using the Benefits Eligibility Screening Tool (BEST) by visiting www.ssa.gov on the web.  You can also contact your local Social Security office or call the toll-free number at 1-800-772-1213.  TTY 1-800-325-0778.   

Enrollment Information

Please remember that if you are already enrolled in one of the HealthSun benefit plans then you should not enroll in a stand-alone Part D Plan (PDP) because your HealthSun plan already includes a prescription drug plan.  Enrollment into a PDP plan will automatically disenroll you from HealthSun.  Click here to see how you can enroll with HealthSun Health Plans, or to find other information on enrollment/disenrollment. 

 

Make sure the plan you choose covers the drugs you take – Explore which drugs each plan covers.  Click here to see information on our Prescription Drug Benefits.   

Help Resources

Centers for Medicare & Medicaid Services

Website: www.medicare.gov
Toll-free: 1-800-Medicare (1-800-633-4227)
TTY: 1-877-486-2048
24 hours a day, seven days a week

 

Social Security Administration

Website: www.ssa.gov
Toll-free: 1-800-772-1213
TTY: 1-800-325-0778
7 a.m. to 7 p.m., Monday through Friday