My bowling buddy Earl told me something last spring that stopped me cold. He'd been splitting his blood pressure pills in half to make a 30-day bottle last two months.
"Earl," I said, "have you ever looked into Extra Help?" He waved me off. "That's for people with nothing. I own my house." Earl is a retired school bus driver living mostly on Social Security. He'd ruled himself out without ever checking.
Well, folks, a few weeks later he applied. He was approved. His monthly drug costs went from a real worry to a few dollars a prescription. And the pill splitting stopped that same week.
What is Medicare Extra Help?
Extra Help is a federal program that helps people with limited income and savings pay for Medicare Part D prescription drug costs. You'll also see it called the Part D Low-Income Subsidy, or LIS. Depending on your plan, it can help with your monthly drug plan premium, your deductible, and what you pay at the pharmacy counter.
It's run through Social Security, it's free to apply, and there's no penalty if you apply and don't qualify. Medicare's page on help with drug costs lays out the official options.
Who qualifies for Extra Help?
In plain words, there are two roads. If you already get full Medicaid, a Medicare Savings Program, or Supplemental Security Income, you qualify for Extra Help automatically. Everyone else with limited income and savings can apply through Social Security, online at ssa.gov/extrahelp or by phone at 1-800-772-1213. Applying is free, and there's no penalty if you're turned down.
The income limit is roughly 150 percent of the federal poverty level, and there's a separate limit on savings. Those numbers change every year, so check the current ones on the National Council on Aging's Extra Help chart instead of trusting a number someone told you at church.
Does owning my home mean I can't get Extra Help?
This is the mistake Earl made, and it's a common one. Social Security doesn't count the home you live in toward the savings limit, and it generally doesn't count your car either. What counts is things like money in the bank, stocks, and bonds.
So don't rule yourself out because of your house. Let Social Security do the math. That's their job.
How do I apply for Extra Help?
Here are the steps in words. Gather your bank statements and the amounts of your income, like Social Security and any pension. Apply online at ssa.gov/extrahelp or call Social Security. Keep a copy of what you send and the decision letter you get back. Then check whether your drug plan still makes sense with Extra Help.
That last step matters. Extra Help covers plan premiums up to a set regional amount, so if your plan costs more than that, you pay the difference. With Medicare open enrollment starting October 15, this fall is a good time to compare.
What if a medicine is still too expensive?
Please don't do what Earl did. Splitting or skipping pills without talking to your doctor can be dangerous. Tell your doctor or pharmacist the cost is a problem. They may know a lower-cost option, and our guide on using GoodRx at the pharmacy shows one more way to compare prices.
How Earl's pharmacy trips changed
Earl picks up his prescriptions on the same day every month now, whole pills, full bottles. The application took him one afternoon at his kitchen table with his daughter on speakerphone. The hardest part, he says, was admitting he might need a little help.
There's no shame in using a program you paid into your whole working life, folks. That's what it's there for.
Do you know someone who might qualify for Extra Help and doesn't know it? Share this with them, and tell us in the comments if you have questions.
