Who Should Complete This Application For Extra Help With Costs under the Medicare Prescription Drug Coverage?
You should complete this application for Extra Help if: • You have Medicare Part A (Hospital Insurance) and/or Medicare Part B (Supplementary Medical Insurance); and • You live in one of the 50 states or the District of Columbia; and • Your income is below $16,245 if you are not currently married or not living with your spouse, or $21,855 if you are currently married and living with your spouse; and • Your savings, investments, and real estate are not worth more than $12,640 if you are not currently married or not living with your spouse, or $25,260 if you are currently married and living with your spouse. (DO NOT include the home you live in, vehicles, personal possessions, burial plots, irrevocable burial contracts or back payments from Social Security or SSI.) If you have more than those amounts, you may not qualify for the Extra Help. However, you can still enroll in an approved Medicare prescription drug plan for coverage.
