On June 12, the Biden-Harris Administration is announcing new tools to lower prescription drug costs for low-income people with Medicare through the Extra Help program, which provides eligible seniors and disabled people with help paying for their Medicare Part D premiums and cost-sharing. These resources complement forthcoming expansions in Extra Help benefits and will ensure more people eligible for benefits are enrolled in this vital program.
In August 2022, President Biden signed the Inflation Reduction Act into law—one of the most consequential health care laws since the Affordable Care Act (ACA). Among several policies intended to lower prescription drug costs, the law expands eligibility for the full low-income subsidy benefit—known as the Extra Help program—to individuals with limited resources and incomes up to 150% of the federal poverty level, or $21,870 per year - PDF in 2023 for most individuals, who meet eligibility criteria.
Beginning January 1, 2024, eligible seniors and people with disabilities will benefit even more through the expansion of the Extra Help program. Nearly 300,000 low-income people with Medicare currently enrolled in the Extra Help program stand to benefit from the program’s expansion.1 People with Extra Help currently with partial benefits who will be newly eligible for full benefits will pay no deductible, no premium, fixed lower copayments for certain medications, and could save nearly $300 per year, on average, according to estimates .
Up to 3 million seniors and people with disabilities could benefit from the Extra Help program now but aren’t currently enrolled. The expansion of the Extra Help program provides an important opportunity to those who could benefit from the program’s lower cost premiums, deductibles, and copayments—now and when the program expands in 2024.
As such, the Department of Health and Human Services (HHS), through the Administration for Community Living (ACL) and the Centers for Medicare & Medicaid Services (CMS), is announcing actions to reach eligible seniors and people with disabilities and improve enrollment in Extra Help as follows:
- ACL is announcing targeted efforts, informed by a comprehensive equity analysis, to reach, screen, and enroll people in the Extra Help program, specifically focused on Americans living in rural and underserved communities. These efforts will leverage data made available by CMS and involve ongoing technical assistance to grantees in the Medicare Improvement for Patients and Providers Act (MIPPA) program, the State Health Insurance Assistance Program (SHIP) , and other ACL grantees working with communities.
- CMS is releasing new national data on people with Medicare Part D prescription drug coverage living in the community who currently benefit from Extra Help, those who are expected to save more on prescription drug costs thanks to the program’s expansion in 2024, and those who are likely eligible for Extra Help but not enrolled. This data set includes key demographic information like age, gender, race and ethnicity, marital status, living alone, metro status, limited English proficiency, disability status, and other community characteristics.
- CMS is making available an outreach toolkit for beneficiary advocates and community-based organizations to raise awareness of the Extra Help program’s benefits and how to enroll, including social media content - PDF and a consumer-friendly article - PDF, and will encourage drug plans to assist eligible individuals in enrolling in Extra Help.
- In addition, CMS will continue to:
- Educate partners and advocates through the National Medicare Education Program.
- Train SHIP counselors, agents, and brokers through annual Open Enrollment training.
- Include information on Extra Help in the Medicare & You handbook, which is sent each year to more than 60 million people with Medicare.
- Remind people with Medicare about Extra Help through emails and social media.
- Train 1-800-MEDICARE call center representatives to provide callers information on Extra Help.
These actions build on a targeted mailing to 1.2 million seniors and disabled people from the Social Security Administration (SSA) to reach people who may be eligible for Extra Help and Medicare Savings Programs (MSPs) with information on how to enroll in the programs, as well as a targeted mailing from CMS about the Extra Help program’s expanded benefits. Through MSPs, low-income people with Medicare benefit from cost savings, as their premiums and, in some cases, cost-sharing are covered through Medicaid at no cost. Further, these efforts build on CMS’ proposed policies to simplify and streamline enrollment in MSPs for low-income older adults and people with disabilities. CMS is committed to cutting red tape to ensure the application, verification, enrollment, and renewal processes for MSPs are less burdensome for people to navigate.
Get Help with Health Care Coverage and Costs:
- More information on the Extra Help program is available at www.Medicare.gov/ExtraHelp. To enroll in the Extra Help program, visit SSA online at www.ssa.gov/extrahelp or call 1-800-772-1213.
- For one-on-one assistance with Extra Help, MSPs, or other Medicare questions, contact your State Health Insurance Assistance Program (SHIP) at www.shiphelp.org/ or call 1-877-839-2675 to get the number for your local SHIP. Or, call 1-800-MEDICARE (1-800-633-4227) for help. TTY users can call 1-877-486-2048. Additional information on other benefits available in your area can be found at benefitscheckup.org .
- During the height of the pandemic, the eligibility determination process for Medicaid was put on pause to ensure low-income Americans did not lose access to critical care during the public health emergency. Medicaid redeterminations are now beginning again in states across the country. If you are currently enrolled in Medicaid, please make sure your information with the state is up to date.
Lowering Health Care Costs and Expanding Coverage:
The Biden-Harris Administration has made expanding access to high-quality, affordable health care a top priority, and with the Inflation Reduction Act, millions of Americans will see lower health care and prescription drug costs. In addition to expanding Extra Help benefits, key provisions of the Inflation Reduction Act include:
- Capping a month’s supply of each covered insulin at $35 for people with Medicare;
- Making recommended vaccines available at no cost for people with Medicare prescription drug coverage;
- Eliminating catastrophic cost-sharing and capping annual out-of-pocket drug costs for prescription drugs for people with Medicare Part D starting in 2024;
- Allowing Medicare to negotiate better prescription drug prices;
- Requiring drug companies to pay a rebate to Medicare if they raise their prices faster than inflation; and
- Continuing enhanced premium tax credits that helped 13 million people covered under the ACA an average of $800 on their Marketplace health insurance in 2022