Thu. Apr 25th, 2024
Medicare Extra Help (MEPS): A Complete Guide

 This program assists low-income people and families with the costs of Part D (prescription medication coverage). One federal program called Medicare Extra Help assists individuals in covering the cost of prescription medications covered by Medicare. Individuals with low incomes are eligible for the program.

Extra Help for Medicare is not a part of Medicare. As a form of support, the Social Security Administration (SSA) is in charge of managing the program.

How to Be Eligible and Submit an Application

Some people may not need to apply for Medicare Extra Help since they naturally qualify. These consist of: 

  • people with Medicare Savings Programmes
  • people who receive Supplemental Security Income 
  • and people who receive both Medicaid and Medicare

The Centres for Medicare and Medicaid Services (CMS) usually notify those who satisfy the aforementioned qualifying requirements that they are exempt from needing to apply for Extra Help.

Depending on Their Income,

People who don’t fit the aforementioned standards can still be eligible for Medicare Extra Help. A person must fulfill the following requirements to be eligible for the Extra Help program:

  • Medicare Part A, Part B, or both are available to them.
  • They are American citizens.
  • They fulfill the requirements for income.

Application Process

A person must apply in person at a nearby Social Security office or online through the SSA to be eligible for Medicare Extra Help. After reviewing their eligibility, the Social Security Administration notifies applicants via mail if they are eligible for Extra Help.

A person cannot sign up for Medicare Part D by applying for the MedicareExtra Help Programme. That is a different process that entails choosing a plan and vetting insurance companies.

Income Requirements

Depending on their income, people who may not automatically qualify for Medicare Extra assistance may nevertheless meet the program’s requirements.

Medicare Extra Help’s income requirements are subject to annual adjustment. The program’s level of assistance can vary depending on an individual’s assets and monthly income.

The Medicare Rights Centre states that the following are among the requirements for 2020:

  • assets worth up to $14,610 for single people 
  •  $29,160 for a married couple living together, 
  • according to the Social Security Administration,
  •  $1,615 for a single person
  • below $2,175 for a couple each month.

The following are eligible for full Medicare Extra Help:

  • a maximum monthly salary of $1,456 for an individual
  • assets worth up to $9,360 for singles, 
  • and a monthly income of up to $1,960 for married couples
  • assets for married couples up to $14,800

When evaluating a person for the Extra Help program, the SSA considers the following assets:

  • combined stocks, 
  • bonds, 
  • savings accounts, 
  • real estate.

Not Included in the Assets Are:

  • life assurance
  • graves automobiles
  • individual belongings

Those who are still determining if they fit the requirements can still apply. Certain income and asset combinations might not be eligible.

What Does Extra Help with Medicare Cover?

A Medicare Part D plan’s expenses are partially covered by care Extra Help. Understanding Medicare Part D can help you grasp what it entails. Prescription medication coverage falls within this optional Medicare benefit area. Medicare Part D is also available to those who qualify for Medicare Parts A and B.

Under a contract with the federal government, private insurance firms can provide Medicare Part D coverage. Purchasing prescription medications through the insurer’s network of pharmacies is a requirement of Medicare Part D enrollment. Nonetheless, Medicare Part D recipients typically still have out-of-pocket costs, which can mount up.

People who have a Part D plan, for instance, are still responsible for paying for some prescription expenses. The individual’s choice of plan and the drugs they take will determine the precise cost of Part D.

Medicare Extra Help offers financial support to help individuals cover the following costs:

premiums each month for Medicare Part D deductibles copayments for prescription drugs

Benefits

Having Medicare Extra Help has advantages and benefits, such as the following:

It assists consumers in paying Medicare Part D premiums: Through a private insurer, people acquire Medicare Part D. The cost of premiums varies. Up to a certain level, Medicare Extra Help covers that premium.

However, this amount differs from state to state and also depends on whether an individual is eligible for full or partial Extra Help.

It lowers the price of prescription medications: Medicare Extra Help helps with copayments, lowering the enrollee’s total prescription cost.

It offers Medicare Part D’s Special Enrollment Period: Generally speaking, enrollees may only modify their Medicare Part D plan between mid-October and early December, during the fall open enrollment period.

Nonetheless, once per calendar quarter, those receiving Extra Help are eligible to enrol in Medicare Part D or change their plan during a Special Enrollment Period.

There is no Medicare Part D late enrollment cost. As long as a person has Medicare Extra Help, delaying Part D enrollment does not result in penalties under Medicare.

Any Additional Fees or Charges

It doesn’t harm to apply for Medicare Extra Help even though not everyone is eligible.

If the SSA approves someone for the program, there won’t be any additional fees or expenditures for them to pay.

For More Information: Grants for Rural Innovation

What Lower Drug Costs Does Medicare Extra Help With?

The amount that Medicare Extra Help lowers prescription drug prices varies for those who are eligible.

According to SSA estimates, each beneficiary of Help saves roughly $5,000 annually on prescription medication expenses.

Medicare Extra Help lowers prescription costs in several ways. It reduces the Medicare Part D monthly premium. Individuals who are eligible for complete Extra Help pay no premium and are not subject to a deductible.

Additionally, in 2020, the copayment for generic medications is $3.60, while the copayment for brand-name medications is $8.95. They will no longer be required to pay a copayment when purchasing prescriptions once they have reached $6,350.

Part D of Medicare covers copayments for prescription drugs. The Part D copayment might be less than the Medicare Extra Help copayment because these could differ. Those eligible for Extra Help pay the smaller of the two copays.

You Can Also Read It : The Affordable Care Act (ACA)

Reapplying Each Year

A person’s eligibility for Medicare Extra Help in one year does not guarantee them eligibility in the next.

Every enrollment year, an individual must demonstrate that they meet the Extra Help requirements since circumstances can change.

Requalification procedures can change based on how an individual first satisfied the requirements. For instance, to maintain eligibility, a person might need to apply and submit proof of income.

Conclusion

A social security program called Medicare Extra Help gives Medicare Part D beneficiaries additional funding. It can assist people in paying for their deductible, monthly premium, and any prescription copayments. Based on their assets and income, the SSA grants approval for individuals to participate in the Extra Help program.

By Jack

Jack, a U.S.-based freelance writer with a wealth of experience in the loan and subsidy industry, is more than just a wordsmith. Driven by a passion for financial education and consumer empowerment, he founded cuploanprogram.online. This blog serves as a platform for his expert advice and insights, aiming to demystify loan programs and promote fair and transparent lending practices for all.