Extra help and the impacts on my Part D plan benefit!

Your membership with us will not change just because you are getting extra help in paying for your prescription drug coverage. You will receive the same benefits as someone who is not receiving extra help.

As a member who receives extra help paying for your prescription drug coverage, you may receive lower:

  • Monthly premiums
  • Prescription co-payments
  • Yearly deductible

What extra help is available?

If you have limited income and resources, you may qualify for extra help from the government in paying your monthly premium, yearly deductible, and prescription co-payments and co-insurances. Resources include your savings and stocks, but not your home or car. This extra help will count toward your out-of-pocket costs.

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Do I qualify for extra help?

There are two ways you may qualify for extra help.

1. You automatically qualify for extra help and don’t need to apply if you:

  • have full coverage from a state Medicaid program.
  • get help from Medicaid paying your Medicare premiums (belong to a Medicare Savings Program).
  • get Supplemental Security Income benefits.

You can get additional information regarding how you automatically qualify for extra help. Medicare mails letters monthly to people who automatically qualify for extra help.

2. You may apply and qualify if your annual income is below $16,245, single with no dependents (or $21,855 if married, and living with your spouse and no dependents). In addition, your resources (including your savings and stocks, but not your home or car) must not exceed $12,510 (or $25,010 if married and living with spouse). How much extra help you get will depend on your income and resources.

Status Income Resources  
Single Less than $16,245 Less than $12,510  
Married (living with spouse) Less than $21,855 Less than $25,010  

The above income and resource amounts are for 2009 and will change in 2010. If you live in Alaska or Hawaii, or pay at least half of the living expenses of dependent family members, income limits are higher.

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How do I apply for extra help?

If you qualify for extra help with your Medicare Prescription Drug Plan costs, your premium and drug costs will be lower. To see if you qualify, call 1-800-MEDICARE (1-800-633-4227), 24 hours a day, 7 days a week. TTY users should call 1-877-486-2048. You may also call your State Medicaid Office or the Social Security Administration at 1-800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday. TTY users should call 1-800-325-0778.

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What will my premium be if I receive extra help?

If you qualify for extra help, you will pay $0.00 or a reduced monthly Part D premium. View the SilverScript Insurance Plan Premium Extra Help page and select your State to see what your premium will be.

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What should you know about the application for extra help?

Social Security has developed a form to apply for extra help that you can complete. Family members, caregivers and other third parties also can help you complete the application.

To prepare:

  • Identify the things you own alone, with your spouse or with someone else, but do not include your home, vehicles, burial plots or personal possessions.
  • Review all your income.
  • Gather your records in advance to save time.

The records you will need are:

  • Statements that show your account balances at banks, credit unions or other financial institutions;
  • Investment statements;
  • Life insurance policy statements;
  • Stock certificates;
  • Tax returns;
  • Pension award letters; and
  • Payroll slips.

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What if I’ve been told I no longer qualify for extra help?

You may still qualify for extra help, but you must apply to find out. If you haven’t already filled out an application for extra help, you can get an application or apply over the phone by calling Social Security at 1-800-772-1213, or apply online at www.socialsecurity.gov. TTY users should call 1-800-325-0778. Click here to download an application.

You have the right to appeal the decision. To file your appeal, you will need to fill out a form from Social Security.

If you qualify for extra help with your Medicare Prescription Drug Plan costs, your premium and drug costs will be lower. To see if you qualify, call Social Security toll-free at 1-800-772-1213. TTY users may call at 1-800-325-0778.

If you believe you are paying an incorrect co-payment amount when you get your prescription at a pharmacy because you have qualified for extra help, we are here to help you confirm your eligibility. We follow Medicare’s Best Available Evidence policy so if you have the necessary documentation, we can help you sort out your eligibility issues. Call Member Services at 1-866-552-6106, our highly-trained representatives are always ready to help.

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How often do I need to reapply for extra help?

Social Security will review your eligibility every year. If you do qualify for extra help, you will not need to reapply.

If you received a letter that said you did not qualify and you think you should be eligible, you need to reapply. You can apply or get more information about extra help by calling Social Security at 1-800-772-1213 (TTY 1-800-325-0778) or visiting www.socialsecurity.gov.

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Where can I get more information?

For additional information on how to apply or what you must do to qualify, click here.

You should have received a letter from Medicare if you automatically qualify for extra help. If you think you may qualify, contact the Social Security Administration at 800-772-1213, visit www.ssa.gov on the Web, or apply at your State Medical Assistance office. TTY/TDD users should call 800-325-0778. After you apply, you will get a letter in the mail letting you know whether you qualify and what you need to do next.

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What are the 2010 Low Income Subsidy copayment amounts?

Medicare Part D Hierarchy 2010

Copay Category
by tier		 Generic Copay Brand Copay* Low Income Premium Subsidy** Deductible Amount
1 2.50 6.30 100%
2 1.10 3.30 100%
3 0.00 0.00 100%
4 15% 15% 100% $63
4 15% 15% 75% $63
4 15% 15% 50% $63
4 15% 15% 25% $63

* If a person has a low income subsidy and the brand drug is covered by the formulary, a person will be charged the standard brand copayment. There is no reference based pricing penalty or brand/generic difference applied.

** If you receive extra help, some or your entire monthly premium may be paid for by Medicare.

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Do you need Extra Help for things other than prescription benefits?

If you do need Extra Help, please view BenefitsCheckup.org. Benefitscheckup.org is a site developed and maintained by the National Council on Aging (NCOA) that provides seniors with limited resources a Web-based service that screens for benefits programs and tells you how and where to apply.Benefits Checkup has helped more than 2 million seniors find help with benefits, totaling more than $7.7 billion worth of annual benefits they deserve.

Click BenefitsCheckup.org for links that can help you such as applying for extra help from Medicare, housing locators, or other available benefits. BenefitsCheckUp includes more than 1,550 public and private benefits programs from all 50 states and the District of Columbia, such as:

  • Prescription drugs
  • Nutrition (including Food Stamps)
  • Energy assistance
  • Financial
  • Legal
  • Health care
  • Social Security
  • Housing
  • In-home services
  • Tax relief
  • Transportation
  • Educational assistance
  • Employment
  • Volunteer services


CVS/pharmacy has partnered with NCOA to help millions of older Americans eligible for public and private benefits, but not receiving them, with one place to go to get them."