Apply for Medicare assistance: a few minutes could save you money
The federal government says millions of Americans—about one in three people with Medicare—qualify for extra help with Medicare costs associated with prescription drug coverage. You could be one of them, but you have to apply to find out.
What kind of help is available?
Depending on your income, resources, and other factors, you may be eligible for certain federal, state, and local programs that help with Medicare beneficiaries' medical costs. These programs include:
- Help with prescription drug costs – The federal government helps millions of Medicare beneficiaries pay their prescription drug costs. Those who qualify for extra help enjoy free or reduced drug coverage premiums and reduced out-of-pocket costs. Some people qualify for prescription drug help automatically, while others need to apply.
- Medicaid – This joint state and federal program helps people with limited income and resources pay for healthcare. For information about Medicaid, call your State Medical Assistance office. You can find the number on the Medicare Website
or call 1-800-MEDICARE. (1-800-633-4227); (TTY users call 1-866-653-4261) 24 hours a day, 7 days a week.
Programs of All-inclusive Care for the Elderly (PACE) – A combination of medical, social, and long-term care services available only in states that choose to offer it under Medicaid. Eligibility requirements vary from state to state. For details, contact your State Medical Assistance office.
Medicare Savings Programs – A program where your state Medicaid program helps you pay your Medicare premium and, in some cases, deductibles and coinsurance. Millions of people receive help through Medicare Savings Programs, which have different names in different states. For more information, call your State Medical Assistance office.
Supplemental Security Income (SSI) benefits – Help for people who are disabled, blind, or over age 65 AND have limited financial resources. SSI is NOT the same as Social Security benefits. For more information, call Social Security at 1-800-772-1213 (TTY: 1-800-325-0778) 24 hours a day, 7 days a week or contact your local Social Security office. You can also use the Benefits Eligibility Screening Tool (BEST) on the Social Security Website to find out if you're eligible.
How do I get extra help with prescription drug costs?
- Some people qualify automatically because they participate in Medicare AND another program, such as Medicaid, Medicare Savings Programs, and Social Security Income (SSI) benefits. The government has already contacted these people about extra help, but they still need to choose a prescription drug plan.
- Millions of others qualify because of limited income and resources, but they need to apply. The Social Security Administration accepts applications by mail and on their Website at www.ssa.gov.
- Applying for extra help is NOT the same as joining a prescription drug plan. Whether you qualify for extra help or not, you must also enroll in a plan to get prescription drug coverage.
What if I'm not sure I qualify for extra help?
If you're not sure you qualify for help with prescription drug costs, go ahead and apply. There's no risk and no cost, so you might as well try!
Who qualifies for extra help automatically?
You receive extra help with Medicare costs automatically if you have Medicare and also have:
- Programs of All-inclusive Care for the Elderly (PACE)
- Medicare Savings Programs
- Supplemental Security Income (SSI) benefits
How do I choose a plan?
Since you use the Internet, you have easy access to information that can help you select your plan. Make sure the plan you choose:
Covers the drugs you take – Explore which drugs each plan covers. Go to the plan's Website or use the "Formulary Finder" on the Medicare Website.
Let's you use your favorite pharmacy – Find out which pharmacies are in a given plan's network. Visit the plan's Website or call its Customer Service phone number.
What if I discover my plan isn't a good fit?
If the plan you're enrolled in doesn't meet your needs, you can switch to another one during the annual election period (Oct. 15–Dec. 7). Medicaid and PACE participants can change plans anytime. Medicare Savings Program and SSI participants may also change plans at any time. Your effective date will be the first day of the month after you switch plans.
Applying for help if you don't qualify automatically
It's estimated that a third of people with Medicare can get extra help with Medicare costs—but the government may not know if you're one of them! For that reason, it's a good idea to apply for extra help, even if you're not sure you qualify. With a quick visit to the Social Security Administration Website, you can find out if you're eligible and even apply online.
How do I find out if I qualify for extra help?
To see if you qualify, visit the Medicare section of the Social Security Administration Website, at www.ssa.gov. Click on the tab, Find Out if You Qualify, located at the bottom of the page, and then answers the questions listed in the application to find out if you qualify. Once you determine your eligibility, you can proceed to the Apply Now tab.
You can also obtain the simple, four-page application from your local Social Security office or by call the SSA at 1-800-772-1213, (TTY: 1-800-325-0778) Monday – Friday, 7 a.m. to 7 p.m.
* It is important to remember that applying for extra help is NOT the same as joining a prescription drug plan. Whether you qualify for extra help or not, to get prescription drug coverage you have to choose to enroll in a Medicare Advantage plan with prescription drug coverage or a stand-alone prescription drug plan.
How much help will I receive if I qualify?
The amount of extra help varies based on your income and resources.
Where to find more information
Centers for Medicare & Medicaid Services
Toll-free phone: 1-800-633-4227
24 hours a day, 7 days a week
Social Security Administration
Toll-free phone: 1-800-772-1213
Monday through Friday 7 a.m. to 7 p.m. Eastern time
Toll-free phone: 1 - 888 - 223 - 9950
8 a.m. to 8 p.m. Monday - Friday