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Choosing A Medicare Part D Plan With Extra Help

Having a Medicare Part D prescription drug plan can be a great way to help in saving money on expensive prescription medications. Oftentimes, the cost of these items make up the largest portion of a senior’s budget – and this can be tough. This is especially the case for those who may be living on a fixed income. But what about those who are unable to afford the premiums on Medicare Part D drug coverage?

The good news is that there is help available through Medicare’s Extra Help program. In fact, for those who meet certain income and resource qualification guidelines, the cost for generic drugs (in 2014) could be no more than $2.55 each, and the cost of each brand name covered drug could be no higher than $6.35 each.

How To Choose A Part D Plan

Once a person has qualified for Medicare’s Extra Help program, it will still be necessary to choose the right Medicare Part D prescription drug plan for your specific needs. Just like any other Medicare enrollee, those who are in the Extra Help program have the right to enroll in the Medicare drug plan of their choosing. Therefore, you should do so based on the medications that you take. There are, however, some other details to be mindful of as a participant in Extra Help.

First, for those who have automatically qualified for Extra Help and have not immediately chosen a Part D drug plan, Medicare will choose one for you. This will happen so as to ensure that you will continue to receive your medications. This is especially important for those individuals who are being switched over from Medicaid coverage to Medicare for their prescription drug coverage.

When Medicare chooses a plan for a participant, it does so at random. This means that the plan that Medicare chooses for you may or may not necessarily be the best one for you based on the medications that you take. In fact, the plan may not even cover the medications that you take at all. However, being in the Extra Help program allows an individual to switch to another plan whenever the person wants to. This can be a big help in getting out of a plan that does not work for you and into one that does.

Understanding Exactly What “Zero Premiums” Means

It is also important for those who are in the Extra Help program to understand exactly what Medicare means by the term “zero premiums.” When enrolled in Extra Help, individuals do not have to pay premiums for their Medicare Part D prescription drug coverage. However, the premium is waived only if the participant joins a drug plan that charges regular premiums that are under a certain dollar amount.

Under the rules of Medicare, individuals do not have to pay a premium if they are in a plan with a premium that is below the average of all plan premiums in their region in any given year. However, if the enrollee joins a more expensive plan, they will be required to pay the difference between the average premium and the full premium.

As an example, if the average premium in a person’s region is $40 per month, and the premium in the plan that the person joins is $47 per month, then the individual will be required to pay $7 per month for his or her drug coverage.

This regional average – also referred to as a “benchmark,” will typically change each year. When this occurs, Medicare will send a letter to some Extra Help enrollees letting them know that if they remain in their current plan for the following year, they will no longer be able to claim zero premiums.

In other instances, the letter may inform the Extra Help enrollee that he or she has been switched over to another Part D prescription drug plan that does have zero premiums. Therefore, it will be important to read all of the notices that are received from Medicare and from the Part D plan that arrive. Otherwise, it is possible that a zero premium plan could turn into a plan with required premiums unexpectedly.

In order to determine which plans in a certain area offer zero premium and which do not, information can be located in the Medicare Plan Finder program. These details may be found on Medicare’s website, as well as by contacting Medicare directly via phone, or by calling your local State Health Insurance Assistance Program (SHIP).


MedicareWallet.com is an unbiased, online resource for individuals turning 65 or already on Medicare. Our utmost goal is to provide information in a way that is user-focused, informative and ethical. With a combined 40 years of experience in the Medicare market, we can answer any questions about Medicare and Medigap insurance. Feel free to reach out to us at 800.376.0824 or by email atinfo@medicarewallet.com.

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