Extra Help If You Have Limited Income
If you have limited income, you may qualify for a Medicare program called Extra Help.
Depending on your income, Medicare could pay some or all of your costs, including
- monthly premiums
- deductible
- coinsurance or copayments.
In addition, you would not have to pay a late enrollment penalty or the full cost of your drugs during the coverage gap, if your plan has that feature.
To find out if you qualify for Extra Help, contact
- 1-800-MEDICARE or 1-800-633-4227, available 24 hours a day, 7 days a week. TTY users should call 1-877-486-2048.
- your local Social Security office or call 1-800-772-1213, from 7 a.m. to 7 p.m., Monday through Friday. TTY users should call 1-800-325-0778.
- your state Medicaid office.
|
Your level of Extra Help
|
Basic Plan
|
Basic Plus Plan
|
Copayment Plan
|
Enhanced Plan
|
Enhanced Plus Plan
|
|
100%
|
$0.00
|
$8.85
|
$57.80
|
$119.50
|
$183.45
|
|
75%
|
$4.70
|
$16.85
|
$65.80
|
$127.50
|
$191.45
|
|
50%
|
$12.60
|
$24.75
|
$73.70
|
$135.40
|
$199.35
|
|
25%
|
$20.60
|
$32.75
|
$81.70
|
$143.40
|
$207.35
|
|
No Extra Help
|
$28.60 |
$40.75 |
$89.70 |
$151.40 |
$215.35 |
If You Qualify for Extra Help and Are Not Paying The Correct Copayment
Please contact us if you
- have qualified for Extra Help, and
- are not paying the right copayment amount when you get your prescriptions filled at a pharmacy.
We will help you to
- request help in getting the necessary proof of the correct copayment you should be paying, or
- provide us with proof, if you already have it.
You can send any of the following documents — also known as best available evidence — to the NRECA Plan. They also can be submitted by your pharmacist, advocate, representative, family member or other individual acting on your behalf:
- a copy of your Medicaid card that includes your name
- a copy of a state document that confirms active Medicaid status
- a print out from the State electronic enrollment file showing Medicaid status
- a screen print from the State’s Medicaid systems showing Medicaid status
- other documentation provided by the State showing Medicaid status
- a copy of the Social Security Administration award letter
- a remittance from the facility showing your Medicaid payment for a full calendar month
- a copy of a state document that confirms Medicaid payment on your behalf to the facility for a full calendar month
- a screen print from the State’s Medicaid systems showing your institutional status based on at least a full calendar month stay for Medicaid payment purposes.
When we receive the proof from Medicare showing your copayment level, we will
- make sure that you can pay the correct copayment when you get your next prescription at the pharmacy
- reimburse you if you paid a higher copayment.
We will make the payment to
- the pharmacy if it hasn’t collected a copayment from you and/or is carrying your copayment as a debt owed by you
- a state if the state paid on your behalf.
If you have any questions, please contact Customer Care.