What to do if you no longer automatically qualify 

for Extra Help with Medicare prescription drug costs

Revised November 2018

What’s Extra Help?

Getting Extra Help means Medicare helps pay your Medicare Prescription 

Drug Plan’s monthly premium, deductible, and copayments. You automatically 

qualify for Extra Help if you have one of these:

• Both Medicare and Medicaid

• Help from Medicaid paying your Medicare Part B (Medical Insurance)

premiums (belong to a Medicare Savings Program)

• Both Medicare and Supplemental Security Income (SSI)

Note: You need to join a Medicare drug plan to get Extra Help.

If I automatically qualify this year, will I qualify next year?

You may no longer qualify for Extra Help if your income and resources 

changed since last year and you no longer qualify for one of the programs listed 

above.

You’ll get a notice (on grey paper) in the mail along with an application and 

postage-paid envelope by the end of September if you no longer automatically 

qualify for Extra Help. The good news is, even if you get this notice, you may 

still qualify for Extra Help. You need to apply to find out. You can apply for 

Extra Help through Social Security or the Medicaid office in the state where 

you live. If you don’t qualify, you’ll have to start paying a monthly premium. If 

you don’t make these payments, you may be disenrolled from your drug plan.

If you still qualify for Extra Help but the level you qualify for is changing in 

2019, you’ll get a notice (on orange paper) in the mail in early October that 

will show your new copayment amounts. If you don’t get a notice from 

Medicare, you’ll get the same level of Extra Help in 2019 that you got for 2018, 

although your actual copayment amount may change due to yearly 

adjustments to the Extra Help program. You’ll still get a notice from your drug 

plan letting you know what your copayments for 2019 will be.
2

What should I do if I don’t qualify automatically?

You should apply for Extra Help if:

• Your yearly income is $18,210 or less for an individual or $24,690 or less for a 

married couple living together. Even if your yearly income is higher, you still 

may qualify if you or your spouse meet one of these conditions: 

– You support other family members who live with you.

– You have earnings from work.

– You live in Alaska or Hawaii.

• Your resources are $14,100 or less for an individual or $28,150 or less for a 

married couple living together. Resources include your savings and stocks, but 

not your home or car or the value of any life insurance you may have.

The above amounts are for 2018 and may change in 2019. If your income and 

resources are slightly higher, you should still apply.

How do I apply for Extra Help?

It’s free to apply for Extra Help. Apply as soon as possible to make sure you get 

Extra Help starting January 1, 2019, if you qualify. There are 3 ways to apply:

1.Visit socialsecurity.gov/i1020.

2.Call Social Security at 1-800-772-1213 to apply by phone, get a paper 

application mailed to you, or make an appointment at your local Social Security 

office. TTY users can call 1-800-325-0778.

3.Visit Medicare.gov/contacts or call 1-800-MEDICARE (1-800-633-4227) to get 

the phone number of your local Medicaid office. TTY users can call 

1-877-486-2048.

What if I still don’t qualify for Extra Help?

If you don’t qualify for Extra Help, look at these other options for lowering your 

prescription drug coverage costs:

• Your state may have programs that can help pay your prescription drug 

costs. Contact your Medicaid office or State Health Insurance Assistance 

Program (SHIP) for more information. Visit Medicare.gov/contacts for your 

Medicaid office’s phone number, and visit shiptacenter.org for your SHIP’s 

phone number.
3

What if I still don’t qualify for Extra Help? (continued)

• You may want to switch to a new Medicare drug plan for coverage starting 

January 1, 2019. See what your costs will be in 2019 for your current plan without 

the Extra Help. Compare other plans in your area to your current plan to see if 

you can save more money.

You can compare plans by visiting Medicare.gov/find-a-plan. Or, call 

1-800-MEDICARE (1-800-633-4227) for help. TTY users can call 

1-800-486-2048. You can also call your SHIP for assistance. Visit shiptacenter.org

for your SHIP’s phone number. When you’re comparing plans, be sure the plan 

covers the prescriptions you take. Also see if you can continue to use your same 

pharmacy to fill prescriptions if using that pharmacy is important to you.

• If you no longer qualify for Extra Help for the following year, you have an 

additional opportunity to switch plans from January 1–March 31, 2019. 

Remember, you can re-apply for Extra Help at any time if your income and 

resources change. 

For more information

For information about Extra Help, visit socialsecurity.gov/prescriptionhelp. 

You also can call Social Security at 1-800-772-1213. TTY: 1-800-325-0778.

For more information about Medicare prescription drug coverage: 

• Read your “Medicare & You” handbook.

• Visit Medicare.gov.

• Call 1-800-MEDICARE. 

• Call your SHIP for free personalized health insurance counseling. 

Visit shiptacenter.org for your SHIP’s phone number.

You have the right to get Medicare information in an accessible format, like large print, 

Braille, or audio. You also have the right to file a complaint if you feel you’ve been 

discriminated against. Visit Medicare.gov/about-us/accessibility-nondiscriminationnotice, or call 1-800-MEDICARE (1-800-633-4227) for more information. TTY users can 

call 1-877-486-2048.

Paid for by the Department of Health & Human Services.
CMS Product No. 11215