Dear Marci, I’m enrolled in the federal Extra Help program. Will there be changes to my benefits in 2018? How will I know about them? – Ava Huntington, WV Dear Ava, There are several changes that can happen for people with Extra Help, a federal program that helps pay Medicare prescription drug costs, before and during Fall Open Enrollment. If a change is being made to your Extra Help coverage, you will be mailed a notice sometime in September, October, or November. Look out for the colors and titles of these notices to find out if you need to take action to change or keep your Extra Help benefits. If you receive an orange notice, you do not need to take action. This is the “Change in Extra Help Copayments” Notice, and you may receive it sometime in October. This notice explains if the Extra Help copays will change in 2018. Copays usually change a small amount each year. Read this notice to learn how much you will pay for your covered drugs in 2018, and save it for your records. If you receive a blue notice, you might need to take action. There are two kinds of blue notices, and they are both called Reassignment Notices. The first kind of Reassignment Notice is sent out in October to people whose Medicare Advantage (MA) plans or Part D drug plans are leaving the Medicare program. If you receive this notice, it means that you will be reassigned to a new MA or Part D plan in 2018. If you want to choose your own plan, you will have to choose it by December 31, 2017. If you do not take action, you will be automatically enrolled in a different plan that may or may not fit your prescription drug needs. The second kind of blue Reassignment Notice is sent in October to people whose MA or Part D plan premiums have risen above the Extra Help benchmark (the maximum premium amount that Extra Help will cover). If you receive this notice, it means you will be assigned to a new plan in 2018. If you want to choose your plan, you should do so before December 31, 2017. Otherwise, you will be automatically enrolled in a new plan. If you receive a gray notice, you should be prepared to take action, because it means that you could be losing Extra Help or paying more in the coming year. The first kind of gray notice is a “Loss of Deemed Status” Notice. This notice is sent in September to people who will no longer qualify to get Extra Help in 2018. If you get this notice, but you think it is a mistake (because your income hasn’t changed and/or you’re still below the income and asset limits for Extra Help), you should reapply for Extra Help right away so you don’t lose coverage in 2018. You can apply by calling the Social Security Administration at 1-800-772-1213, visiting your local Social Security office, or applying online here. The second kind of gray notice is the “Low-Income Subsidy Choosers” Notice. You will receive this in November if you chose your current drug plan (instead of being automatically enrolled in one), and your plan premium is increasing above the Extra Help benchmark amount in the coming year. If you receive this notice, it means that you have to actively change your plan to one with a lower premium. If you do not actively switch to a plan with a premium below the Extra Help benchmark, you will pay part of the premium (the difference between the premium amount and the benchmark amount) in 2018. – Marci

Dear Marci,

I am new to Medicare. My income and assets are on the low side and I’m having difficulty paying for my prescription drugs. A neighborhood counselor told me about Extra Help. Do you think this is something for me?

– Stefano (Rock Springs, WY) 

Dear Stefano,

Extra Help, also referred to as the Low-Income Subsidy (LIS), is an option worth exploring. This is a federal program that helps pay for Medicare prescription drug coverage (Part D) costs. In 2017, if your monthly income is below $1,528 for singles ($2,050 for couples) and your assets are below specified limits, you may be eligible. Even if your income or assets are above the limit, you may still qualify for Extra Help because certain types of income and assets may not be counted. For example, if you are a homeowner, your house is exempt.

If you are approved for enrollment in a Medicare Savings Program (MSP), then you will be automatically enrolled in Extra Help. Your Extra Help benefits will have the same effective date as your MSP benefits.

If you do not qualify for an MSP, but you do qualify for Extra Help, you can apply through the Social Security Administration (SSA) using either the agency’s print or online application atwww.ssa.gov. You may qualify for full or partial Extra Help. With full Extra Help, you should pay no Part D premium as long as you choose a plan that offers basic coverage and has a premium at or below the Extra Help benchmark premium amount for your state. The benchmark amount varies by state. You will also pay no deductible and have low copays for your drugs. If you have partial Extra Help, in 2017, you will pay a share of your plan’s premium, an $82 deductible, and reduced copays.

If you have Extra Help, you will have a Special Enrollment Period (SEP) to change your prescription drug coverage up to once per month. You can choose a new stand-alone Part D plan, enroll in a Medicare Advantage Plan with prescription drug coverage, or disenroll from your Medicare Advantage Plan and enroll in a stand-alone Part D plan with Original Medicare. Changes made usually take effect the first of the following month. For example, someone may want to change their plan if they need to take a drug that their current plan does not cover. If this person has Extra Help, they have the option of enrolling in a new plan that does cover their drug.

Stefano, depending on the availability in your state, there other two other programs that can help with your Medicare prescription drug costs: state pharmaceutical assistance programs (SPAPs) and patient assistance programs (PAPs).

An SPAP is a state-based program that can help pay the cost of your drugs. Not all states have an SPAP. SPAPs have specific eligibility requirements, application instructions, and rules you must follow in order to get the benefit. You can contact your State Health Insurance Assistance Program (SHIP) to learn if there is an SPAP in your state, or visitwww.medicare.gov/pharmaceutical-assistance-program/state-programs.aspx.

A drug manufacturer can offer a PAP, which is an assistance program that provides discounts on certain drugs. These programs can be an option if your income and assets are too high to qualify for a Medicare Savings Program and/or Extra Help. There are different PAPs, and each generally offers discounts on a specific type of brand name or generic medication. The drug manufacturers, not the state or federal government, provide the discounts. Each program has eligibility requirements, application instructions, and rules you must follow to get the benefit. For example, some PAPs only work if you do not have Medicare prescription drug coverage. You can contact your SHIP to learn more about PAPs, or visitwww.rxassist.org or www.needymeds.org.

To find your SHIP’s contact information, you can go towww.shiptacenter.org or call 1-877-839-2675 for assistance. A SHIP counselor can help you understand your situation and discuss your specific health insurance needs.

– Marci