Extra Help Copays 2019

Posted : admin On 1/2/2022

Premiums, co-pays, co-insurance, and deductibles may vary based on the level of Extra Help you receive. Please contact the plan for further details. Disclaimer for Chronic Condition Special Needs Plan (SNP): This plan is available to anyone with Medicare who has. 2019 Copayment Rates Effective date June 6, 2019. Outpatient Services. Basic Care Services $15 / visit. Services provided by a primary care clinician. Specialty Care Services $50 / visit. Services provided by a clinical specialist such as surgeon, radiologist, audiologist, optometrist, cardiologist, and specialty tests such as magnetic resonance imagery. S had full Extra Help and a monthly income below $1,094, his copays would be $1.30 for generics and $4.00 for brand-name drugs, making his generic Extra Help copay less costly than the plan copay of $1.35. This means that Mr. S would pay the Extra Help copay throughout the year.

The Federal Government provides an extensive program for people needing financial assistance with the Medicare Part D program. Depending on your income and available financial resources , Medicare will provide 'Extra Help' that may cover 85% to 100% of prescription costs and may also pay a part or all of your Medicare Part D premiums.
Medical copay help

Who Qualifies for 'Extra Help'?

For the plan year 2021 If your income is below $19,320 per year for a single person (or $26,130 for a married couple living together or even more if you have dependent children or grandchildren living with you), AND if your assets (resources) are below $13,290* for a single person (or $26,520* if you are married). *These limits do not include the $1,500 per person burial exclusion, see more details below.

Help With Insurance Copays


The following items are NOT included in income:
  • Housing assistance,
  • Medical treatment and drugs,
  • Food stamp assistance, etc.
Click Here to see more payments that do NOT count toward income.

$1,500 per person Burial Exclusion:
All beneficiaries are permitted a $1,500 per person burial exclusion from their resources. This exclusion can be taken into account by either reducing your resources by $1,500 per person (Medicare & Your Handbook) or by increasing the resource limit by $1,500 per person (Most other Social Security Administration and Medicare documents). Below is a chart showing the resource figures with, and without taking into account the burial exclusion:Help
Maximum Resource LimitWith $1,500 Burial ExclusionWithout $1,500 Burial Exclusion
Individuals$14,790$13,290
Couples$29,520$26,520

The following items are included in resources:

How To Get Help With Medical Copays


  • bank accounts,
  • stocks and bonds,
  • Real estate (other than your primary residence), etc.
The following items are NOT included in resources:
  • the house you live in,
  • your car,
  • other personal possessions such as your furniture and jewelry, etc.
  • burial plots,
  • up to$1,500 for burial expenses (per person), or
  • life insurance policies.
Click Here to see more assets that do NOT count toward resources.

How To Get Copay Assistance


Click on the year below to change the above qualification figures to the selected year:
202020192018201720162015201420132012201120102009200820072006
If you receive the full Extra-Help, full LIS, or are dual eligible for Medicare and Medicaid, there are Medicare Prescription Drug plans in your state the will qualify for the $0 monthly premium. Click on your state below to see PDP plans that qualify for the $0 premium:
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Who Should You Contact for 'Extra Help'?

What Is Copay Assistance Program

What Medicare Beneficiaries Who are interested in qualifying for financial 'extra help' with the Medicare Part D Prescription Drug plans should visit http://www.socialsecurity.gov/i1020

Also see: