Prescription medications are one of the largest ongoing expenses for many seniors. Fortunately, there is a little-known federal program called “Extra Help” that can dramatically reduce the cost of Medicare prescription drugs.
Many people qualify for this benefit without realizing it. This post will explain Extra Help in Florida and what seniors need to know about the program.
What Is Extra Help?
Extra Help, also known as the Low-Income Subsidy (LIS), is a federal program administered by the Social Security Administration (SSA). Its purpose is simple: to help people with limited income and resources pay for their Medicare Part D prescription drug costs.
Although people often hear about Extra Help through state agencies, it is not a Florida Medicaid program. It is a nationwide Medicare benefit available to eligible Floridians.
What Costs Does Extra Help Cover?
Extra Help can significantly reduce or eliminate many out-of-pocket prescription drug costs, including:
- Monthly Part D premiums
- Annual deductibles
- Prescription copayments and coinsurance
- Costs during the Medicare “coverage gap” (donut hole)
For those who qualify, Extra Help can lower prescription costs to just a few dollars per prescription. In many cases, generic drugs may cost only a small copayment, while the program caps brand-name drugs at a modest amount.
Who Is Eligible for Extra Help?
The SSA bases Extra Help eligibility on income and resources, not age or medical condition. The limits are higher than many people expect.
Income Guidelines
To qualify, income must generally be at or below 150% of the Federal Poverty Level. For many seniors, this means that even with Social Security, a pension, or modest retirement withdrawals, they may still qualify.
Certain income exclusions and deductions apply, so gross income alone does not always determine eligibility.
Resource (Asset) Limits
Applicants must also have limited countable assets, such as:
- Bank accounts
- Stocks or bonds
- Certain retirement accounts
However, the program does not count key assets, including:
- Your primary residence
- One vehicle
- Household belongings
- Prepaid burial arrangements
That means many homeowners with modest savings may still qualify.
How Do You Apply?
The Social Security Administration handles applications for Extra Help. You can apply:
- Online
- By phone
- In person at a Social Security office
Some individuals are automatically enrolled, including those who already receive Medicaid or certain Medicare Savings Programs. Others must apply directly.
Why Extra Help Matters
Prescription drug costs can quickly strain a fixed income, especially for individuals with chronic conditions or multiple medications. Extra Help can save eligible seniors thousands of dollars per year, making medications more affordable and improving access to necessary care.
Unfortunately, many people never apply because they assume they earn too much or have too many assets. The reality is that you might be closer to qualifying than you think.
What This Means For Florida Seniors
Extra Help is a valuable Medicare benefit that:
- Reduces prescription drug costs
- Has more generous income limits than many expect
- Is available to eligible Floridians
- Can make a meaningful difference in monthly expenses
If you or a loved one is struggling with the cost of medications, exploring Extra Help eligibility is an important step in protecting both health and financial security.
Frequently Asked Questions About Extra Help in Florida
Is Extra Help the same thing as Medicaid?
No. Extra Help is a federal Medicare program, not a Medicaid benefit. While some people who receive Medicaid automatically qualify for Extra Help, you do not need to be on Medicaid to be eligible. Many seniors who would not qualify for Medicaid still qualify for Extra Help.
Do I have to be low-income to qualify for Extra Help?
Extra Help is for individuals with limited income and assets, but the income limits are higher than many people expect. Seniors with Social Security income, pensions, or modest retirement savings may still qualify.
Will Extra Help cover all of my prescription drug costs?
Extra Help does not usually cover the complete costs, but it can drastically reduce out-of-pocket expenses. Monthly premiums, deductibles, and copayments often drop to very low amounts.
Will owning a home or car disqualify me from Extra Help?
No. Your primary residence and one vehicle are exempt as countable resources for Extra Help eligibility. Many seniors who own their home and have a car still qualify, even if they also have some savings.
How does Extra Help fit into long-term care or Medicaid planning?
Extra Help can be an important part of an overall long-term care planning strategy. Reducing prescription costs can help seniors preserve income and assets. These savings may be critical when planning for long-term care or future Medicaid eligibility. An elder law attorney can help coordinate these benefits as part of a larger plan.
Not Sure if You Qualify? We Can Help
Are you or a senior loved one interested in learning more about Extra Help? Do you need help with long-term care planning or navigating Medicaid eligibility?
Reach out to the Scott Law Offices. Our elder law experts can help you get the benefits you deserve and ensure clear and effective planning.
