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Helping Hands: Drug coverage available for those stuck in ‘doughnut hole’

Q: I have a Prescription Drug Plan Part D, and last year I had trouble paying for my drugs because I got into the “doughnut hole.” Is there any help available for me?

A: Yes. If your monthly income is below $1,459 for individuals ($1,966 for couples) and your assets are below $13,640 for individuals ($27,250 for couples), you may be eligible for Extra Help, a federal program that helps to for some or most of the costs of Medicare prescription drug coverage.

Q: How do I apply?

A: If you are enrolled in Medicaid, Supplemental Security Income or a Medicare Savings Program , you automatically qualify for Extra Help. You do not have to apply for this extra assistance.

If you are not enrolled in one of the programs that automatically qualify you for Extra Help, you will need to fill out an application to apply. You can do that through the Social Security Administration using the agency’s printed or online application (available at www.ssa.gov), or at your local county assistance office or Apprise office.

Q: How will this help me if I am approved?

A: You would have little or no premium or deductible, very low co-pay amounts, and the doughnut hole (or coverage gap) would be eliminated for you. Qualifying for Extra Help also triggers a continuous special enrollment period, which means you can change plans any time. Coverage begins the first day of the following month.

If you do not have a Part D plan and become eligible for Extra Help you will get as SEP to enroll in a Medicare private drug plan. You will not have to pay a Part D premium penalty, even if you enroll in a Medicare private drug plan after you were first eligible. If you are found eligible for Extra Help and you do not choose a drug plan, Medicare will choose one for you.

Q: Must I reapply every year?

A: If you receive a letter from the SSA regarding a “Review of Your Eligibility for Extra Help” that includes a form asking about income and resources, it must be completed and returned to determine whether you will qualify for the program the following year. Even if income/resources do not change, you should still complete it and send it in.

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