Extra Help for Drug Costs

If your monthly income is below $1,561 a month for a single people or
 $2,114 for couples and your assets are below the specified limits below, you may be eligible for Extra Help: a federal program that helps you pay for some or most of the costs of Medicare prescription drug coverage. 

Your combined savings, investments, and real estate are not worth more than $28,720 if you are married and living with your spouse, or $14,390 if you are not currently married or not living with your spouse. 

(DO NOT include the home you live in, vehicles, personal possessions, burial plots, irrevocable burial contracts or back payments from Social Security or SSI.) If you have more than those amounts, you may not qualify for the extra help. 

You apply for help paying for your Medicare drug benefit through the Social Security Administration using either the agency's print or online application. This application can also enroll you in the Medicare Savings Program, which helps pay your Medicare costs. To be sure you get all the benefits you qualify for, complete the entire Extra Help application, even if you do not think you qualify for Extra Help.

You can call the Social Security Administration to ask for an Extra Help paper application at 1-800-772-1213.

Client Resources

Shingles Vaccine

Confusion on How Medicare Covers the Shingles vaccine?

If you have a Medicare Part D plan, it must cover your shingles vaccine. In fact, all Medicare Part D plans must include all commercially available vaccines on their formularies (list of covered drugs), including the shingles vaccine.

Your Part D plan will pay for the vaccination itself and for your doctor or other health care provider to give you the shot. Before you get a vaccination, you should first check coverage rules with your Part D plan to see where you can get your shot covered at the lowest cost.

You typically pay the least for your shingles shot if you are vaccinated at:
* a pharmacy that is in your drug plan’s network (an “in-network” pharmacy); or
* a doctor’s office that:
* can work with a network pharmacy that will bill your Part D plan for the entire cost of the vaccination; or
* can bill your Part D plan for the vaccine, directly.

If you receive the shot from an in-network pharmacy or from a doctor’s office that can bill your Part D plan, you should only need to pay the plan’s approved copay at the time you get vaccinated.

If you get the shingles vaccine from a doctor’s office that cannot bill your Part D plan, you may need to pay more for it. In this case, you will have to pay the entire cost of the vaccination up front and then follow your Part D plan's rules to get a refund. When you are refunded by the plan, you will only be refunded your Part D plan’s approved amount for the vaccination. Keep in mind that you will be responsible for the difference between the doctor’s charge and the plan’s approved amount.

If you have Extra Help, the federal program that helps pay for your prescription drugs, you can go to any doctor or in-network pharmacy. Your vaccination will be covered and you will only be responsible for the Extra Help copay. However, you may need to pay the entire bill up front and then be reimbursed by your Part D plan, if you get vaccinated by a doctor or health care provider who doesn’t directly bill your Part D plan.

Remember, the only vaccines that Part D doesn’t cover are vaccines that prevent the flu, pneumonia, and hepatitis B. These vaccines are covered under Medicare Part B.