Health & Benefits

You may qualify for Extra Help to pay for all or part of your Medicare Part D premiums and other costs.

Some people are automatically eligible and do not need to apply. They still need to enroll in a Prescription Drug Plan. Others may qualify if their income and resources are below a certain level. They will need to apply for it.

To qualify for Extra Help:

• You must reside in one of the 50 States or the District of Columbia;
• Your resources must be limited to $16,660 for an individual or $33,240 for a married couple living together. Your home, car, or any life insurance policy do not count; and
• Your annual income must be limited to $21,870 for an individual or $29,580 for a married couple living together. If your income is higher, you still may be able to get some help.

You are automatically eligible for Extra Help if you receive Medicare, and:

• You also receive Medicaid (if so, you are considered a dual-eligible person);
• You also receive Supplemental Security Income (SSI); or
• You get help from your state Medicaid program paying your Medicare premiums (Medicare Savings Program).

If you are automatically eligible, you will get the full benefit of Extra Help. This means that you will not have:

• A monthly premium,
• An annual deductible, or
• A coverage gap in the donut hole.

Applying for Extra Help

If you are not automatically eligible, you must apply. You may apply:

• Through a Social Security Administration office
• Through an Illinois Department of Human Services (DHS) office, or
• Online.

There is an advantage to applying through DHS. You can ask DHS to review your eligibility for Medicaid or other programs that help you pay other Medicare costs under Parts A and B. 

Applying through the Social Security Administration may be easier, though. For example, SSA usually will not require you to bring papers proving your income.

Extra Help benefits for people who have to apply

There are different levels of Extra Help available. They depend on your income and assets. People with a lower income and fewer assets get more help with their Medicare drug plan costs. Learn more about the benefits of both Full Extra Help and Partial Extra Help.

Nobody receiving Extra Help has to worry about the donut hole. Income and asset limits increase every year. The SSA sets the new amounts in February or March. They are effective immediately.

Extra Help co-payments (and the amount of the deductible for people who receive the partial benefit) increase at the beginning of each calendar year. They remain the same for that whole year.

Eligibility for Extra Help

By law, SSA is required to review a beneficiary's eligibility for Extra Help periodically. When it is time for your review, the SSA will send you a form called "Social Security Review of Your Eligibility for Extra Help" or the SSA-2016 form. You have 30 days to complete and return this form. Any changes to your Extra Help will start in January of the following year.

If you disagree with SSA's decision on your review, you can appeal. You must appeal within 60 days of the date of SSA's notice. Use form SSA-1021 to make this appeal.

SSA will set up a telephone hearing with you to review their case. If the SSA upholds the decision, you can appeal the decision.

Learn more about Extra Help.