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Medicare Part D - Extra Help Program

Medicare Part D - Extra Help Program

People with Medicare may enroll in Part D coverage through either a stand-alone plan or a Medicare Advantage plan. People on Medicare who choose not to enroll and have no other drug coverage may pay more for late enrollment.

Important Dates:

  • October Announcement of Part C and Part D plans for the upcoming year. Visit www.medicare.gov to compare plans Medicare open enrollment begins October 15
  • December Medicare open enrollment ends December 7
  • January New plans and plan changes take effect January 1

 

What Are My Medicare Options?

Original Medicare Part A Hospital  |  Part B Medical + Medicare Supplement + Prescription Drug Coverage

  • Original Medicare Part A Hospital and Part B Medical: Fee-for-service coverage under which the government pays your health care providers directly for your Part A and/or Part B benefits.
  • Medicare Supplement (secondary insurance): Sold by private insurance companies to fill “gaps” in Original Medicare coverage. Others may have coverage through a retirement health plan or Medicaid.
  • Prescription Drug Coverage: Sold by private insurance companies to fill “gaps” in Original Medicare coverage. Others may have coverage through a retirement health plan or Medicaid.

Medicare Advantage Plans (HMOs and PPOs Part C)

Offered by private companies that contract with Medicare to provide Part A and Part B benefits. Plan types include health maintenance organizations (HMOs), preferred provider organizations (PPOs), private fee-for-service plans and more. These plans take the place of Original Medicare and most include the Part D prescription drug benefit.

What Is Medicare Part D?

Part D is Medicare’s comprehensive prescription drug coverage benefit and is available to anyone eligible for Medicare Part A or Part B. People with Medicare may enroll in Part D coverage through either a stand-alone plan or a Medicare Advantage plan. People on Medicare who choose not to enroll and have no other drug coverage may pay more for late enrollment.

What Does Part D Cost?

In 2021 the Medicare Part D out-of-pocket costs for consumers are:

  • Average Monthly Premiums - $37.00
  • Annual Deductible - $0 - $445
  • Copays - 25% or flat copay amounts based on formulary.
  • Initial Coverage Limit - $4,130
  • Out-of-Pocket Threshold - $6,550
  • Catastrophic Coverage - $10,313

How Do I Choose A Part D Plan?

Each year you should review your plan options and look for three things:

  • Convenience - Know what pharmacies are in network and if the plan has preferred pharmacies
  • Cost - Know all possible out of pocket expenses
  • Coverage - Make sure all your current prescription medications are included

What Is The Extra Help Program?

Extra Help is a Medicare program that helps people with limited income and resources pay Medicare prescription drug costs. You may qualify for Extra Help, also called low-income subsidy (LIS), if your annual income and total resources are below these limits this year: prescription medications are included:

Single Person:

  • Monthly Income $1,630
  • Resources $14,790

Married Person:

  • Monthly Income $2,198
  • Resources $29,520

For help applying for Extra Help benefits, contact the OSHIIP Program at the Ohio Department of Insurance at 1-800-686-1578.

What Counts As Income And Resources?

Resources include money in a checking or savings account, stocks, bonds, mutual funds, and Individual Retirement Accounts (IRAs). Resources don’t include your home, car, household items, burial plot, burial expenses (up to $1,500 per person), or life insurance policies. Income includes any money received from social security, pensions, employment, interest and more.

If you qualify for Extra Help, Medicare will pay:

  • All or most of the monthly premium
  • All or most of the annual deductible
  • Most of your copayments/co-insurance 
  • Full coverage during the donut hole

In 2021, drug costs for most people who qualify will be no more than $3.70 for each generic drug and $9.20 for each brand name drug. Look on the Extra Help letters you get, or contact your plan to find out your exact costs.