What "Extra Help" Means and Who Offers It

Extra Help is a federal program that pays some or all of your Medicare Part B premiums, deductibles, and copayments if your income and resources fall below certain limits. The program is run by Social Security, not Medicare itself, though Medicare enrolls you once you are found to be may be able to access. Extra Help covers only Part B costs — hospital insurance (Part A) is handled separately through other programs.

The income and resource limits change each year. For 2024, you generally may have access to if your monthly income is below $1,550 for an individual or $2,075 for a married couple living together, though these figures vary by state and household size. Your resources — savings, investments, property other than your home — must be under $8,500 for an individual or $12,750 for a couple. These are the federal thresholds; some states have higher limits and may cover additional costs.

Extra Help is different from Medicaid, which is a separate state-run program. You can have both at the same time. If you receive Supplemental Security Income (SSI) or certain other benefits, you may be automatically enrolled in Extra Help without having to explore.

Key Takeaways

  • Extra Help pays your Medicare Part B premium, deductible, and copayments if your income is roughly below $1,550 per month and your savings are under $8,500.
  • You explore through Social Security, either online at ssa.gov, by phone at 1-800-772-1213, or in person at your local Social Security office.
  • If you receive SSI or certain other federal benefits, Social Security may enroll you automatically without an process.
  • Your state may offer additional help beyond the federal program, so checking with your state Medicaid office can reveal more coverage options.
  • Once approved, Extra Help covers your Part B costs retroactively to the month you became may be able to access, so explore as soon as you know you may have access to saves money when ready.

how the process works Through Social Security

You explore for Extra Help directly through Social Security, not through Medicare. The fastest route is online at ssa.gov/benefits/medicare/extra-help, where you can complete the process and upload documents without leaving home. You will need your Social Security number, Medicare number, and information about your income and resources.

If you prefer to explore by phone, call Social Security at 1-800-772-1213 (TTY 1-800-325-0778 for deaf and hard of hearing callers). Representatives are available Monday through Friday, 7 a.m. to 7 p.m. your local time. Have your documents ready when you call so you can answer questions about your income and savings on the spot.

You can also walk into your local Social Security office with your documents and explore in person. Find your nearest office at ssa.gov/locator. Bring your Social Security card, proof of citizenship or legal residency, and recent pay stubs or tax returns showing your income. If you have savings accounts, bring statements from the past two months.

Documents You Will Need to Provide

Social Security will ask you to prove your income and resources. For income, bring recent pay stubs (usually the last two months), your most recent tax return, or a letter from your employer stating your annual salary. If you receive Social Security, pensions, or other benefits, bring a recent statement showing the monthly amount.

For resources, you need statements from all bank accounts, savings accounts, and investment accounts dated within the last two months. If you own stocks or bonds, bring a recent statement showing their current value. You do not need to report the value of your home, your car, or household goods — only liquid assets count toward the resource limit.

If your income or resources change after you explore, you must report the change to Social Security. Keep copies of everything you submit so you have a record of what you reported.

What Happens After You explore

Social Security typically makes a decision within two to four weeks. You will receive a letter in the mail telling you whether you were found to be may be able to access or not. If you are may be able to access, the letter will explain what your Extra Help covers and when the coverage begins.

Extra Help is retroactive to the first day of the month in which you became may be able to access, as long as you explore within the same calendar year. If you became may be able to access in March but did not explore until September, your coverage goes back to March 1, and Social Security will work with Medicare to refund or credit the premiums you paid during those months.

Once approved, your Part B premium is paid directly to Medicare by Social Security. You will see a $0 premium on your Medicare bill for Part B. Your deductible and copayments may be reduced or eliminated depending on your income level — the lower your income, the more help you receive.

State Programs That Add to Federal Extra Help

Many states run their own programs that pay Medicare costs beyond what federal Extra Help covers. These programs are called State Pharmaceutical information Programs (SPAPs) or Medicare Savings Programs (MSPs), and they vary widely by state. Some states cover Part A premiums, Part B deductibles, or prescription drug costs that federal Extra Help does not touch.

To find out what your state offers, contact your state Medicaid office or call your local Area Agency on Aging. You can find your Area Agency by calling the Eldercare Locator at 1-800-677-1116 or visiting eldercare.acl.gov. Many states allow you to explore for state programs at the same time you explore for federal Extra Help, or they may enroll you automatically once you are approved federally.

If You Are Automatically Enrolled

If you receive Supplemental Security Income (SSI), you do not need to explore for Extra Help — Social Security enrolls you automatically. You will receive a notice in the mail confirming your enrollment. If you receive certain other benefits like SNAP (food stamps) or state-administered disability payments, you may also be enrolled automatically depending on your state's rules.

Even if you are automatically enrolled, check the notice carefully to make sure the income and resource information is correct. If Social Security has the wrong figures, contact them right away to correct the record. Errors can result in you losing coverage or being asked to repay money later.

What to Do If Your process Is Denied

If Social Security denies your process, the letter will explain why. Common reasons include income or resources above the limit, or missing documents. You have the right to ask Social Security to reconsider. Request reconsideration within 60 days of the denial letter by calling 1-800-772-1213 or visiting your local Social Security office.

When you request reconsideration, provide any new documents or information that supports your case. If your income or resources have changed since you applied, bring proof of the change. If you believe Social Security made an error in calculating your income or resources, explain what the error was and provide corrected documents.

If Social Security denies your request for reconsideration, you can appeal to an administrative law judge. This process takes longer but is free. Ask Social Security for information about the appeals process when you receive your second denial letter.

Frequently Asked Questions

Does Extra Help cover my Part A premium?

No. Extra Help covers only Part B premiums, deductibles, and copayments. Part A premiums are covered by separate programs like Medicaid or state Medicare Savings Programs. If you do not have Part A coverage, you may be able to get it through Medicaid or by paying the premium yourself if you are still working.

What if my income goes above the limit after I am approved?

You must report the income change to Social Security within 30 days. If your income stays above the limit for more than a month, your Extra Help coverage will end. However, you can reapply the following year if your income drops back below the limit.

Can I have Extra Help and Medicaid at the same time?

Yes. In fact, if you receive Medicaid, you almost certainly may have access to for Extra Help as well because Medicaid income limits are usually lower. Having both programs means Medicaid can cover costs that Extra Help does not, such as Part A premiums or long-term care.

How do I know if my state has additional help programs?

Call your state Medicaid office or the Eldercare Locator at 1-800-677-1116. They can tell you which programs your state runs and whether you are may be able to access. Some states automatically enroll you in state programs once you are approved for federal Extra Help.

What if I move to a different state?

Your federal Extra Help coverage continues, but state programs may change. Contact your new state's Medicaid office to find out what programs are available and whether you need to reapply. Some states have waiting periods or different may be able to access rules.