Medicare Part D - Extra Help

Following are four categories of individuals and/or couples who qualify for "extra help," but must apply to receive it.

NOTE: For purposes of qualifying for extra help, "countable assets" include:
  • Real Estate (other than your primary residence)
  • Bank accounts (checking and savings) and certificates of deposit
  • Investments, including stocks, bonds, mutual funds
  • Individual Retirement Accounts (IRAs)
  • Cash

"Countable Assets" DO NOT include:

  • Your primary residence
  • Personal possessions, such as jewelry and household furnishings
  • Your vehicle
  • Cash value of insurance policies up to $1,500 for an individual and $3,000 for a couple
  • Burial plots
GROUP 1:

You are a Medicare beneficiary and Medicaid (MaineCare) pays for your prescriptions:

  • You will NOT have to pay the Monthly Premium for a standard Part D plan,
  • You will NOT have to pay the Annual Deductible, and
  • Your Co-payments will range from $1-$5, depending on your income.
GROUP 2:

You are a Medicare beneficiary

AND

  • Your monthly income is below $1,077 for an individual or $1,444 for a married couple (including individuals who qualify for a Medicare Savings Program, also known as QMB, SLMB, or QI)

AND

  • Your countable assets are worth less than $6,000 for an individual and $9,000 for a married couple,

THEN

  • You will NOT have to pay a Monthly Premium for a standard Part D plan,
  • You will NOT have to pay the Annual Deductible, and
  • Your Co-payments will range from $2-$5.
GROUP 3:

You are a Medicare beneficiary

AND

  • Your monthly income is below $1,077 for an individual or $1,444 for a married couple (including individuals who qualify for a Medicare Savings Program, also known as QMB, SLMB, or QI)

AND

  • Your countable assets are between $6,000 and $10,000 for an individual or between $9,000 and $20,000 for a married couple

THEN

  • You will NOT have to pay a Monthly Premium for a standard Part D plan,
  • You will pay a $50 Annual Deductible, and
  • Your Co-payments will be approximately 15% of your Part D covered drugs.
GROUP 4:

You are a Medicare beneficiary

AND

  • Your monthly income is between $1,077 and $1,197 for an individual or between $1,444 and $1,604 for a married couple

AND

  • Your countable assets are below $10,000 for an individual or below $20,000 for a married couple

THEN

  • You will pay between $0 and 75% of the Monthly Premium of a standard Part D plan, depending on your income (sliding scale),
  • You will pay a $50 Annual Deductible, and
  • Your Co-payments will be approximately 15% of your Part D covered drugs.

Content provided by Maine Legal Services for the Elderly

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