If you are one of the fortunate that has deciphered Medicare Part D and enrolled in a plan, you should apply for the extra help.
The “Extra Help” is a subsidy Social Security will place on your record if you qualify.
When you qualify for the extra help your out-of-pocket expenses will be greatly reduced.
When you enroll in a plan without the extra help from Social Security your plan costs include premiums, deductibles, and a “gap” in coverage.
Monthly Premiums: The average premium is $37 per month or $240 per year. This premium varies depending on the plan you select.
Annual Deductible: There is a $250 annual deductible you must meet before the coverage starts. This means you will pay $250 at the pharmacy before Medicare pays a dime.
The Gap: This plan has a gap in coverage. Once you reach $2,250 in drug costs you will pay 100% out-of-pocket until you reach $3,660 in drug costs. Above $3,660 of your annual drug expenses you only pay 5% of the cost of your medicine, or $2-$5 co-pays, whichever is greater.
This gap is going to be problematic for many seniors on fixed incomes. This is why you must apply for the “Extra Help” through Social Security.
Medicare Part D Coverage with Extra Help
If you qualify for the full subsidy of “Extra Help” your costs for the plan are listed below.
Monthly Premiums: Zero dollars
Annual Deductible: Zero dollars
The Gap: No gap in coverage. You will only have to pay $1-$2 co-pay for generic drugs and $3-$5 co-pay for brand drugs at the pharmacy.
As you can see coverage with the extra help from Social Security is much better. The extra help is dependent on your income and money in the bank. Social Security does award “partial extra-help” for those above certain income limits; do not assume you will not qualify if you have some money in the bank. To find out if you qualify for the extra help with prescription drug plan costs call Social Security at 1-800-772-1213.