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 and you pay only your coinsurance or copayment 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
|
$11.15
|
$60.85
|
$130.90
|
$209.05
|
|
75%
|
$5.85
|
$18.95
|
$68.65
|
$138.70
|
$216.85
|
|
50%
|
$13.55
|
$26.65
|
$76.35
|
$146.40
|
$224.55
|
|
25%
|
$21.35
|
$34.45
|
$84.15
|
$154.20
|
$232.35
|
|
No Extra Help
|
$29.15 |
$42.25 |
$91.95 |
$162.00 |
$240.15 |
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
- 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 then make the payment to
- the pharmacy if it hasn’t collected a copayment from you and/or is carrying your copayment as a debt you owe
- a state if the state paid on your behalf.
If you have any questions, please contact Customer Care.