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Automatic Extra Help Enrollment for Medicaid Recipients
If you are on Medicaid and also enrolled in Medicare, there is a good chance you are already receiving a powerful benefit called Extra Help — and you may not even know it. Automatic Extra Help enrollment for Medicaid and Medicare recipients is a real program that could save you up to $5,300 per year on prescription drug costs. This article walks you through exactly how it works, who qualifies automatically, and what steps you should take right now to make sure you are getting every dollar of savings you deserve.
What Is Extra Help?
Extra Help — also known as the Low Income Subsidy (LIS) — is a federal program run through Medicare. It is designed to reduce the cost of prescription drugs for people with limited income and resources. The program works alongside Medicare Part D, which is the part of Medicare that covers prescription medications.
Here is what Extra Help can do for you:
- Reduce or eliminate your Part D monthly premiums
- Lower or waive your annual deductible
- Cut your copays down to as little as $0 to $10 per prescription
Over 13 million Americans qualify for Extra Help, but a significant number have never applied — and some do not realize they are already enrolled. That is especially true for people who receive Medicaid.
How Automatic Extra Help Enrollment Works for Medicaid Recipients
If you receive full Medicaid benefits — meaning your state Medicaid program covers your healthcare — you are likely what Medicare calls a dual eligible beneficiary. Dual eligible means you qualify for both Medicare and Medicaid at the same time.
The good news: most people who are fully dual eligible are automatically enrolled in Extra Help by the Social Security Administration. You do not need to fill out a separate application. The government coordinates the information between Medicaid and Medicare on your behalf.
People who are typically auto-enrolled include:
- Full-benefit dual eligible individuals (those with both full Medicare and full Medicaid coverage)
- People enrolled in a Medicare Savings Program, such as the Qualified Medicare Beneficiary (QMB), Specified Low-Income Medicare Beneficiary (SLMB), or Qualifying Individual (QI) programs
- People receiving Supplemental Security Income (SSI) benefits
If you fall into any of these categories, automatic Extra Help enrollment for Medicaid and Medicare recipients likely already applies to you.
What Level of Extra Help Do You Receive?
Not all Extra Help benefits are the same. There are different levels of assistance depending on your specific situation.
Full Extra Help
If you have full Medicaid coverage or receive SSI, you most likely qualify for the highest level of Extra Help. This can mean:
- Your Part D premium may be fully covered up to a benchmark amount
- Your deductible is waived entirely
- Your copays are reduced to the lowest possible amounts, sometimes as low as $0 for certain medications
Partial Extra Help
If you are enrolled in a Medicare Savings Program but do not have full Medicaid, you may qualify for a partial level of Extra Help. You will still see meaningful savings on premiums and copays, though the exact amounts vary by state and by year.
Important: Benefit amounts and thresholds are updated annually and can differ from state to state. Always verify your current benefit level directly with Social Security or Medicare.
How to Confirm Your Automatic Extra Help Enrollment
Even if you believe you are automatically enrolled, it is worth taking a few minutes to confirm. Here is what to do:
- Check your Medicare plan documents: Your Medicare Part D plan should show your cost-sharing levels. If your copays are very low or zero, that is a strong sign Extra Help is active on your account.
- Log into Medicare.gov: You can review your plan details and cost-sharing information through your Medicare account online.
- Call Medicare directly: You can reach Medicare at 1-800-MEDICARE (1-800-633-4227). A representative can confirm whether Extra Help is applied to your account.
- Contact Social Security: Since Social Security administers Extra Help, you can call 1-800-772-1213 or visit ssa.gov to check your status.
- Visit your local Social Security office: An in-person visit can help you get detailed answers and resolve any enrollment issues quickly.
What If You Are Not Automatically Enrolled?
Automatic Extra Help enrollment for Medicaid and Medicare recipients covers many people — but not everyone who qualifies will be enrolled automatically. If you have limited income and resources but are not receiving full Medicaid or SSI, you may still be eligible for Extra Help and simply need to apply.
Applying is straightforward and free. You can:
- Apply online at ssa.gov
- Call Social Security at 1-800-772-1213
- Apply in person at your nearest Social Security office
Good to know: There is no deadline to apply for Extra Help. You can apply at any time of year, and if approved, your savings can begin quickly — sometimes as soon as the following month.
Do Not Leave This Benefit on the Table
Prescription drug costs are one of the biggest financial burdens for older Americans. If you are on Medicaid and Medicare, automatic Extra Help enrollment could already be protecting you — but it is always worth confirming. And if you are not yet enrolled, applying takes only a short time and could put thousands of dollars back in your pocket each year.
Many people assume they are not eligible for additional programs if they are already on Medicaid or Medicare. But Extra Help is specifically designed to work alongside those programs, not replace them. You do not have to choose — you can benefit from all of them at the same time.
Your Next Step
Take action today. Visit ssa.gov to check your Extra Help status or start a new application. You can also call 1-800-772-1213 (TTY: 1-800-325-0778) Monday through Friday during business hours. If you prefer face-to-face help, find your local Social Security office through the office locator at ssa.gov.
Confirming your automatic Extra Help enrollment for Medicaid and Medicare recipients takes just a few minutes — and the savings can last all year long.
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