Understanding Extra Help Copay Levels 2024 for Low-Income Seniors

Low-income seniors can breathe a sigh of relief with the extra help copay levels in 2024. These levels are designed to make prescription medications more affordable.

In 2024, the maximum copay for a 30-day supply of insulin is $35. This is a significant reduction from previous years.

For low-income seniors, the extra help copay levels can be a game-changer. They can save hundreds, if not thousands, of dollars per year on their prescription medications.

The copay levels vary depending on the type of medication, with some medications having a higher copay than others. However, even with the higher copay levels, low-income seniors can still save a significant amount of money.

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To qualify for Extra Help, you must meet certain eligibility criteria. You automatically qualify if you're dual-eligible, receiving Medicaid assistance, or have both Medicare and SSI.

If you don't meet one of these criteria, you may still be eligible if you have Original Medicare, reside in the United States, and have resources below $17,220 for an individual or $34,360 for a married couple.

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To confirm your eligibility, you can apply online or call Social Security at 1-800-772-1213 (TTY: 711) Monday – Friday, 7 a.m. – 7 p.m.

Here are the key eligibility criteria summarized in a table:

To qualify for Medicare Extra Help, you'll need to meet certain criteria. If you're eligible for both Medicare and Medicaid benefits, you automatically qualify.

You can also qualify if you receive assistance from Medicaid in paying your Medicare Part B premiums or are enrolled in a Medicare Savings Program. Another way to qualify is if you have both Medicare and Supplemental Security Income (SSI).

If you don't automatically qualify, you may still be eligible if you meet the following conditions. You'll need to have Original Medicare, which includes both Medicare Part A and Medicare Part B.

You'll also need to reside in the United States. Your resources, including those of a living-in spouse, must be below $17,220 for an individual or $34,360 for a married couple.

If you think you qualify for Extra Help with your Medicare Prescription Drug Plan costs, you can get evidence of your Low Income Subsidy (LIS) eligibility.

You can obtain your prescriptions at the correct LIS cost-sharing level if you have evidence of your LIS eligibility.

To get an application for Extra Help, you can call Social Security at 1-800-772-1213 (TTY: 711), Monday – Friday, 7 a.m. – 7 p.m.

You can also apply online or get an application over the phone by calling Social Security.

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Extra Help covers a wide range of costs for eligible individuals. The program's benefits are substantial, especially for those who qualify for both Medicare and Medicaid.

In 2025, Extra Help will cover no plan deductible and no premiums for Part D drug plans. This means you won't have to worry about upfront costs or monthly payments.

Extra Help also sets limits on copays and coinsurance for prescription drugs. For generic medications, the limit is $4.90 in 2025, and for brand-name drugs, it's $12.15. These limits are in place to keep your costs down and make healthcare more affordable.

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Typically, Extra Help pays for most or some of your Medicare Part D monthly premiums, yearly deductible, and copays and coinsurance for prescription drugs. This can save you a significant amount of money on your healthcare expenses.

Here's a breakdown of the Extra Help copay limits for 2025:

These copay limits can help you budget for your healthcare expenses and ensure that you can afford the medications you need.

If you're eligible for extra help, you'll be glad to know that your health plan costs will be significantly reduced.

There's no monthly premium, so you won't have to worry about paying a monthly fee for your health insurance.

You'll also pay no annual deductible, which means you won't have to pay a certain amount out of pocket before your insurance kicks in.

For generic/preferred multi-source drugs or biosimilars, you'll pay no more than $4.90 for each prescription.

For all other drugs, you'll pay no more than $12.15 for each prescription.

Once your out-of-pocket costs reach $2,000, you'll pay $0 for each covered drug, which can be a huge relief for those with ongoing medical expenses.

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The Social Security Administration (SSA) considers your resources, or savings and assets, when determining your eligibility for Medicare Extra Help. For singles, the resource limit is $17,220 in 2024, while for married couples living together, the limit is $34,360.

Resources that contribute to your eligibility include bank accounts, retirement accounts, investments, real estate that's not your primary residence, and cash.

Here are some examples of resources that contribute to your eligibility:

On the other hand, certain assets are not counted as resources when the SSA assesses your eligibility for Extra Help. These include your home or primary residence, one vehicle, life insurance, burial plot, burial funds, furniture, and household and personal items.

Medicare Resource Limits are an essential factor in determining your eligibility for Extra Help. The Social Security Administration (SSA) considers your income and resources when assessing your eligibility.

The SSA has specific resource limits for singles and married couples living together. For singles, the resource limit is $17,220 (in 2024), while for married couples living together, the limit is $34,360 (in 2024).

Bank accounts, retirement accounts, and investments are all considered resources that contribute to your eligibility. This includes savings, checking, and investments, as well as IRA and 401K accounts.

Certificate of deposits (CD), mutual funds, and other similar investments made through financial institutions are also counted as resources. Additionally, stocks and bonds, including U.S. savings bonds, are considered resources.

Real estate that is not your primary residence and cash are also counted as resources. However, certain assets are not considered resources when determining your eligibility for Extra Help.

Here's a breakdown of resources that are not counted:

If you're eligible for Medicare, you'll need to apply for Extra Help, which helps cover prescription drug costs. You can apply online at ssa.gov/extrahelp.

There are several ways to apply for Extra Help: you can apply online, visit a local Social Security office in person, call SSA to apply over the phone, or request an application form by mail.

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If you're eligible for Extra Help, you'll enjoy significant benefits. People who qualify are automatically enrolled if they have Medicare and qualify for their state's Medicaid program.

You won't have to worry about paying a deductible for your plan. No premiums are required for Part D drug plans either.

The out-of-pocket costs for medications are capped at $12.15 for brand-name drugs and $4.90 for generic medications. This is a relief for those who need prescription medications to manage their health.

Here are the specific costs you can expect to pay for medications: