Extra Help is a Medicare program that helps people with limited income and resources pay their Medicare drug coverage (Part D) premiums, deductibles, coinsurance, and other costs. Some Tennesseans get it automatically, and others have to apply through Social Security. It works the same in Memphis, Nashville, Knoxville, Chattanooga, Clarksville, the Tri-Cities, or a small town like Cumberland Gap.
This article is educational. Instant Health Help is a licensed health insurance agency, and our agent, Lobsang Rivas, is licensed in Tennessee. We are not Medicare, Social Security, TennCare, or an insurance company, and Social Security or the state decides who qualifies. We do not quote prices or name plans here. See Medicare.gov’s official page on help with drug costs (Extra Help).
The short answer
- Some people get Extra Help automatically, without applying.
- Everyone else can apply any time through Social Security, before or after joining a Part D plan.
- Extra Help comes with a special enrollment chance. Medicare.gov says people with Extra Help can change their drug coverage once a calendar month.
Medicare.gov also says you won’t pay a Part D late enrollment penalty while you get Extra Help.
Who gets Extra Help automatically
Medicare.gov says you get Extra Help automatically if you get:
- Full Medicaid coverage. In Tennessee, that is full TennCare coverage.
- Help from the state paying your Part B premiums through a Medicare Savings Program.
- Supplemental Security Income (SSI) payments from Social Security.
If you qualify automatically, you get a notice in the mail. Our guide to Medicare Savings Programs in Tennessee explains how those state programs work.
How to apply if you don’t get it automatically
Social Security takes Extra Help applications:
- Online through Social Security’s Extra Help application page.
- By phone at 1-800-772-1213 (TTY 1-800-325-0778), Monday through Friday, 8 a.m. to 7 p.m. in most time zones. Ask for an appointment to apply for Part D Extra Help.
To qualify you generally must have income and resources below set limits, which may change each year. Medicare.gov posts the current limits, so we don’t repeat them here. Social Security suggests gathering these for you and your spouse:
- Bank statements and tax returns.
- IRA or 401(k) account balances.
- Statements for pensions, veterans’ benefits, annuities, and Railroad Retirement benefits.
Medicare.gov adds that when you apply for Extra Help, Social Security sends your information to the state to start a Medicare Savings Program application, unless you tell them not to.
What happens after you qualify
- You are placed in a drug plan if you don’t have one. Medicare.gov says Medicare enrolls you in a Part D plan so you get your savings, and you can pick a different plan if you want.
- It lasts the rest of the calendar year. Even if your income changes mid-year, you keep Extra Help through December 31.
- Renewal is usually automatic. Medicare.gov says you get a notice only if you no longer qualify or you are moved to a different plan for next year.
- You can reapply any time if you didn’t qualify before and your income or resources change.
The once a month plan change
Most people with Medicare can only change drug coverage at certain times of year. Medicare.gov says that if you have Medicaid or get Extra Help, you can:
- Switch to a different Medicare drug plan, or
- Drop a Medicare Advantage Plan with drug coverage and return to Original Medicare by joining a stand-alone drug plan.
You can make a change once a calendar month, and it takes effect the first day of the next month. This option isn’t available to people a plan has identified as “at-risk” or “potentially at-risk” under a Part D drug management program, and those people get a letter from their plan. If you learn you won’t qualify for Extra Help next year, Medicare.gov gives you 3 full months to change plans. See Medicare.gov’s Special Enrollment Periods page.
Paying the wrong amount at the pharmacy?
If you qualify for Extra Help but think you are being charged the wrong amount, Medicare.gov says to contact your drug plan, which may ask for proof that you get Extra Help, and tell them how many days of medicine you have left. You can also call 1-800-MEDICARE. If you qualify for Extra Help or Medicaid but aren’t in a drug plan yet, Medicare’s Limited Income Newly Eligible Transition (LI NET) program can give temporary drug coverage. Call LI NET at 1-800-783-1307 (TTY 711).
Unbiased counseling in Tennessee
TN SHIP offers Medicare counseling and help applying. Call 1-877-801-0044 or visit the TN SHIP page. Our Tennessee Medicare annual enrollment guide explains what to review each fall, and our Medigap in Tennessee guide covers supplement rules. For family members under 65, see our Tennessee open enrollment guide.
How we help
We are licensed in Tennessee and help by phone and online, in English or Spanish. Learn more on our Tennessee health insurance help page. We can help you see whether you may qualify for Extra Help or a Medicare Savings Program, walk you through the Social Security application, check that your medicines are covered on the plans you are considering, and help you enroll if you decide to. The choice is always yours. Social Security and the state decide eligibility.
Want to talk it through?
Have your Medicare card, your list of medicines, and a rough idea of your monthly income and savings, and we will go over your options step by step.
Call (321) 315-0054 | agent@inshh.com
We do not offer every plan available in your area. Currently we represent 10 organizations which offer 489 products in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.
1-800-MEDICARE (1-800-633-4227), TTY 1-877-486-2048, is available 24 hours a day, 7 days a week, except some federal holidays. Instant Health Help is not connected with or endorsed by the U.S. government or the federal Medicare program.
Featured photo: Cumberland Gap, Tennessee, from Pinnacle Overlook by Bneu2013, CC BY-SA 4.0, cropped with text added.