What Is This Application?
This is an application for Extra Help and does not enroll you in a Medicare prescription drug plan. You will have to enroll directly with an approved Medicare prescription drug provider for coverage. If you need information about Medicare Prescription Drug plans or how to enroll in a plan, call 1-800-MEDICARE (TTY 1-877-486-2048) or visit www.medicare.gov.
Who Should Complete This Application For Extra Help With Medicare Prescription Drug Plan Costs?
You should complete this application for Extra Help on the Internet if:
- You have Medicare Part A (Hospital Insurance) and/or Medicare Part B (Medical Insurance); and
- You live in one of the 50 states or the District of Columbia; and
- Your combined savings, investments, and real estate are not worth more than $25,010, if you are married and living with your spouse, or $12,510 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. However, you can still enroll in an approved Medicare prescription drug plan for coverage.