Do you qualify for “Extra Help” with your prescription costs?

Older Adults - December 6th, 2022

Reading Time: 4 Minute/s

Do you qualify for “Extra Help” with your prescription costs?

Older Adults

Do you qualify for “Extra Help” with your prescription costs?

Posted on December 6th, 2022 - Reading Time: 4 Minute/s

We all know that costs are going up, but what about drug prescriptions? Is there a program that can help with my Medicare drug coverage costs?

Yes, there is! You may be able to get “Extra Help” to pay for the monthly premiums, annual deductibles, and co-payments related to Medicare.

With Medicare there is Original Medicare and Medicare Advantage. With Original Medicare, you buy Parts A (Hospital Insurance), Part B (Medical Insurance) and Part D (Prescription Drug Coverage) separately. Alternatively, you can bundle Parts A, B and D into a Medicare Advantage Plan (Part C). Medicare Advantage Plans, like the ones CHPW offer, include added benefits like vision and dental.

We put together our top three frequently asked questions related to Medicare Part D (drug coverage).


I have Medicare Part D (Prescription Drug Coverage), or a Medicare Advantage Plan so my prescriptions are 100% covered right?

Not necessarily, most Medicare drug plans have a coverage gap (also called the “donut hole”). This means there’s a limit on what the drug plan will cover for drugs. The coverage gap begins after you and your drug plan have spent a certain amount on covered drugs. For 2022, this certain amount is $4,430  and for 2023 this will increase to $4,660.

In this short video, One of our licensed Medicare Experts Brisa Guajardo explains how the donut hole impacts your drug costs.

Meet Brisa Guajardo

Brisa has more than 17 years of health insurance experience and 15 years with CHPW. She has knowledge of Medicare, Medicaid, and related health plans.


Can I just not pay for Medicare Part D?

Not if you want to avoid the late enrollment penalty. This penalty is an amount that’s permanently added to your Medicare drug coverage (Part D) premium. One of our licensed Medicare Experts Brisa Guajardo recommends enrolling in Medicare Part D at the beginning to avoid the late enrollment penalty.

For example: Maria enrolled in Medicare on her 65th birthday but she did not have any form of insurance (through work or Apple Health) to pay for prescriptions. Two years later she enrolls in a Part D (drug coverage) plan. She is now expected to pay a penalty for her prescription drug premium since she didn’t have any Part D (drug coverage) for two years.

If you get Extra Help, you don’t pay the late enrollment penalty.


Is there a program that can help me with my Medicare Part D prescription costs?

Yes! Extra Help is a federal program that helps pay for Medicare prescription drug costs. If you qualify for Extra Help won’t enter the coverage gap. You must be enrolled in a Medicare Part D (Drug Coverage) plan to get this Extra Help. This program is separate from Medicare part D.

Did you know

Did you know?

We call Extra Help Low Income Subsidy at CHPW. This program can lower your monthly premium by helping pay for your Medicare Prescription drug plan costs.



How do I know If I qualify for Extra Help?

You automatically qualify for Extra Help if you:

  • Are 65 years old and qualify for Medicare and
  • Qualify for Supplemental Security Income (SSI). SSI is designed to help aged, blind, and disabled people, who have little or no income; and provides cash to meet basic needs for food, clothing, and shelter or
  • Or are dual eligible which means you are eligible for federal Medicare and you meet the income standards for state health (Medicaid or Apple Health in Washington)

You may qualify for Extra Help if:

  • You have Medicare Part A (Hospital Insurance) and/or Medicare Part B (Medical Insurance); and
  • You live in one of the 50 States or the District of Columbia; and*
  • Your combined savings, investments, and real estate are not worth more than $30,950, if you are married and living with your spouse, or $15,510 if you are not currently married or not living with your spouse. *

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