You help you clients find the best Medicare plans for their needs, but some of them might need a little extra help paying for their prescription coverage.
Even with the 2025 $2,000 cap on prescription drug costs, many seniors find their prescription drugs can be expensive – so expensive that some of your clients might not be able to afford them. That can lead to difficult decisions, like having to choose between skipping potentially life-saving medicine or going without other necessities. The Centers for Disease Control and Prevention found that 4% of Americans over the age of 65 can’t afford their prescriptions at all, and 3% skipped doses or took less medication than prescribed due to cost. This means millions of seniors are risking further health complications due to the cost of their medications.
Help is available. For Medicare enrollees who meet the income and resource limits, the Extra Help program provides low-income subsidies to help with prescription drug costs. Make sure your clients know about this program and how to apply.
Applying for Extra Help
Eligibility for Extra Help is based on income and resources. In 2025, the income limit is $23,475 per year for an individual and $31,725 for a married couple. The resource limit is $17,600 for an individual and $35,130 for a married couple. When calculating resources, the beneficiary’s home, one car, burial plot, furniture, household items and personal items should NOT be included. The beneficiary can also exclude up to $1,500 for burial expenses.
Some people qualify for Extra Help automatically because they receive Medicaid coverage, Supplemental Security Income benefits, or get help from their state paying their Part B premium through a Medicare Savings Program. People who do not automatically qualify can enroll through the Social Security Administration website. If they need help with the application, they can call 1-800-772-1213 (TTY 1-800-325-0778). Before applying applicants should gather the necessary documents which include bank statements and tax returns, IRA and 401K account balances, statements for pensions, annuities, veteran’s benefits, and Railroad Retirement Board benefits if applicable. If applying as a married couple they will need documents for both parties.
Receiving Extra Help
Applying for Extra Help does not enroll Medicare beneficiaries in a prescription drug plan. Make sure your clients also select and enroll in a suitable Medicare plan that includes coverage for any prescriptions they take. If they do not enroll in a Part D plan they will automatically be enrolled in one.
In 2025, Medicare beneficiaries who are receiving Extra Help will pay no more than $4.90 for each generic drug and $12.15 for each brand-name covered drug. Extra Help beneficiaries will also pay $0 for their prescription drug plan premium and deductible.
What About Clients Who Need More Help?
The Extra Help program provides low-income subsidies to help with the costs of prescription drugs, but it does not help with other Medicare costs. If your clients need additional help, they should see if they qualify for the Medicare Savings Programs. To apply for these programs, they will need to contact the Medicaid department in their state. Your clients might also qualify for prescription assistance programs in their state.
Clients who don’t qualify for Extra Help can get some relief from high prescription costs through the Medicare Prescription Payment Plan which allows them to spread their RX costs out over monthly payments, making it easier to afford costly medications.
Many seniors struggle with healthcare costs, and they might not realize that help is available. Reach out to them to make sure they know where to find assistance.
- Tell them about the Extra Help program, as well as the Medicare Savings Programs.
- Encourage them to apply – even if they aren’t sure they qualify.
- Give them links to the Social Security Administration website for Extra Help.
- For help with Medicaid, direct your clients to the Medicaid department in their state. In Texas, they can contact the Texas Health and Human Services Department.
The dedicated team at PTT Financial is here to support you and answer any questions you may have. Give us a call today.
