Who Should Apply for Extra Help?
Many Medicare beneficiaries qualify, so it may be worth your time to learn more and apply.
To see if you qualify,
You must be enrolled in Medicare Part D prescription drug coverage to receive Extra Help. Most CarePlus plans include this Part D coverage. Receiving Extra Help will not negatively affect your health plan coverage.
For more information, please call CarePlus Social Services at 1-855-392-3900 (TTY: 711), Monday – Friday, 8 a.m. – 5 p.m., Eastern time.
If You Qualify Automatically
If you receive Medicaid or Supplemental Security Income (SSI) benefits, or assistance through any of the programs listed below, you will automatically qualify for Extra Help without having to apply:
- Programs of All-Inclusive Care for the Elderly (PACE)
- Medicare Savings Programs
If You Don't Qualify Automatically
Income and assets change periodically, so if you don't qualify automatically for Extra Help, we recommend you still check your eligibility and apply.
If You Didn’t Qualify Before
If there is a change to your income, resources, or marital status, we encourage you to explore if you may be eligible at this time.
Once you are approved for benefits, the Social Security Administration will periodically check to make sure you still qualify. Upon review, if your status changes, you will be notified.
How to Apply
We Can Help You Determine Potential Eligibility and Apply for Benefits
If you want assistance applying for Extra Help, CarePlus can assist you.
Social Security Administration Application
To apply for Extra Help, complete an application at your local Social Security Administration office or apply online:
- Go to the SSA website,
Extra Help With Medicare Prescription Drug Plan Costs - Read the page and select Apply Now.
- Answer questions about your assets and sources of income.
- Enter information about yourself, your spouse (if applicable), and how you can be reached.
- Review and submit your application, and print your "receipt."
The application is secure, which means only you and the Social Security Administration can see the information you provide.
You can also get an application form by calling the Social Security Administration's toll-free number:
(TTY:
Monday – Friday, 7 a.m. to 7 p.m. Eastern Time
How Much Will My Health Plan Cost if I Get Extra Help?
Premium Charts
These charts show plan premium costs, if any, when you enroll in CarePlus and qualify for Extra Help, also known as the Low-Income Subsidy (LIS) program.
Please note that the chart does not include any Medicare Part B premium you may still need to pay. Some people get help paying their Medicare Part B premium from other
If approved for Extra Help, 2024 benefits may include:
- No or reduced monthly premium
- No annual deductible
- Paying no more than $4.50 for each generic/preferred multi-source drug or biosimilar
- Paying no more than $11.20 for all other drugs
- Once your out-of-pocket costs reach $8,000, you’ll pay $0 for each covered drug.
Notification Letter about Costs
If you are a CarePlus member who qualifies for Extra Help, we may send you a notice about your premium, deductible, and copays. It is called a Low-Income Subsidy (LIS) Rider.
You will only receive an LIS Rider if any of your costs will be lower than what is shown in your Evidence of Coverage. We send it when you first enroll and again every September to let you know about changes for the next year. We may send additional LIS Riders if your level of Extra Help changes.
If you receive an LIS Rider, please keep it for your reference.
If you have questions or did not receive an LIS Rider (but believe you should have received one), please
Benefits, premiums, and member cost-share may change on Jan. 1 of each year.
