Extra Help with Medicare Part D

[AndrewF]

Now that I've moved out of my spouse's apartment and am no longer living with him, I qualify for Extra Help with Medicare Part D again.

It's much easier to qualify and sign up for than other assistance programs, so I started with this.

I would be paying over $600 a year in generic drug copays buying 6 months at a time with GoodRX Gold, plus the GoodRX Gold membership, but now that I'm not living with my spouse, Medicare should be paying for a lot of this.

That will relieve me of a substantial amount of medical costs by capping my prescription drug co-pays to $5.10 for generics for 90 day fills, and like $12 and something for brand name fills.

With costs for everything soaring, especially rent and food, everyone who qualifies under Social Security's rules should sign up. Social Security estimates there are at least two million people on Medicare who could get the help who have not applied, and the form is very easy, just asking basic questions about your living situation and how much money you have. 

It even excludes the home you're living in, your most expensive car, and some other things. Check it out if you think you can apply.

As a single person you can now have over $18,000 in countable assets and (iirc) over $1900 a month in total income.

I'll be looking at what other assistance I qualify for now that I'm out of the house. I would have strongly preferred that the marriage had continued in perpetuity had it even been a decent one, but when someone emotionally abuses you for years eventually you cannot take it anymore and would sign a Faustian Contract to get away from them. Which is, I feel, what the rent where I'm living at now is. Very oppressive rent. Have to figure out how to free up enough room to come up with half of it. :/

[crystal626]

Extra Help is very nice. My meds would be $600 without it.

If you're disabled, look into Medicaid. Income limits are higher for disabled people through the waiver system.

Sorry to hear about the split though.

[AndrewF]

The Medicare Savings Program is stingier in many states than Extra Help for Part D.

After I pay off the credit cards for moving in here I might qualify for MSP again but for right now I'm doing what I can.

The problem you run into with MSP is if you're so good with money you manage to save more than the program allows. How messed up is that?

So if you go buy a $5,000 bed for your new apartment then apply you might get back on it, but not if you keep the $5,000 and have a crappy bed.

So get a nice bed, is what I have to say about that. YOLO

[bs1234]

When I was signing up at the end of 2025, Part D program costs in my area varied hugely (and of course there weren't many of them now!)

Since I take some very expensive drugs ($20K per fill) it made sense to go with the cheapest that covered it, which was only $8.95.   The first fill then hits the cap ($2100) and all other covered meds are free.   Other plans were $200 a month and, in my case, for no gain.

Let's see what the sign up for 2027 is like.

[FicoMike0]

You have to check all the plans each year. The one I presently have is "cash back". It refunds nearly all of the part b premium. 

The only downside I've found is blood tests that were previously covered 100% now cost me $10. So, $20-30 a year vs +$150+ a month.

[crystal626]

---

@AndrewF wrote:

The Medicare Savings Program is stingier in many states than Extra Help for Part D.

After I pay off the credit cards for moving in here I might qualify for MSP again but for right now I'm doing what I can.

The problem you run into with MSP is if you're so good with money you manage to save more than the program allows. How messed up is that?

So if you go buy a $5,000 bed for your new apartment then apply you might get back on it, but not if you keep the $5,000 and have a crappy bed.

So get a nice bed, is what I have to say about that. YOLO

---

Yeah the resource limits can be a real pain. They pretty much don't want to help you unless you're one crisis away from homelessness. 

[crystal626]

---

@bs1234 wrote:

When I was signing up at the end of 2025, Part D program costs in my area varied hugely (and of course there weren't many of them now!)

Since I take some very expensive drugs ($20K per fill) it made sense to go with the cheapest that covered it, which was only $8.95.   The first fill then hits the cap ($2100) and all other covered meds are free.   Other plans were $200 a month and, in my case, for no gain.

Let's see what the sign up for 2027 is like.

---

The cap is supposed to go to $2400 next year from what I was reading. 

[Thomas_Thumb]

---

@bs1234 wrote:

When I was signing up at the end of 2025, Part D program costs in my area varied hugely (and of course there weren't many of them now!)

Since I take some very expensive drugs ($20K per fill) it made sense to go with the cheapest that covered it, which was only $8.95.   The first fill then hits the cap ($2100) and all other covered meds are free.   Other plans were $200 a month and, in my case, for no gain.

---

I use Wellcare value script. Monthly premiums were $0 in 2025 but $9.60 in 2026. 

I also take some expensive meds. Reached the $2100 cap with June refills this year. A couple meds dropped over 70% in cost extending time to hitting cap. Last year reached the $2000 cap with March refills.

The current cost killers for me are premiums: Medicare part B $202/mo, basic supplemental with riders and no copays $330/mo, and dental+vision $68/mo. That's $7200 a year just for premiums. Unfortunately, low cost Medicare Advantage plans are not a viable option due to limited acceptance and issues with coverage of procedures/treatments.

[AndrewF]

---

@Thomas_Thumb wrote:

---

@bs1234 wrote:

When I was signing up at the end of 2025, Part D program costs in my area varied hugely (and of course there weren't many of them now!)

Since I take some very expensive drugs ($20K per fill) it made sense to go with the cheapest that covered it, which was only $8.95.   The first fill then hits the cap ($2100) and all other covered meds are free.   Other plans were $200 a month and, in my case, for no gain.

---

I use Wellcare value script. Monthly premiums were $0 in 2025 but $9.60 in 2026. 

I also take some expensive meds. Reached the $2100 cap with June refills this year. A couple meds dropped over 70% in cost extending time to hitting cap. Last year reached the $2000 cap with March refills.

The current cost killers for me are premiums: Medicare part B $202/mo, basic supplemental with riders and no copays $330/mo, and dental+vision $68/mo. That's $7200 a year just for premiums. Unfortunately, low cost Medicare Advantage plans are not a viable option due to limited acceptance and issues with coverage of procedures/treatments.

---

Value Script is still $0 in Illinois.

MSP is a pain in the butt because the State already knows how much is in your bank account because Maximus tells them, but it's like filing taxes.

Every year you have to complete recertification forms then Maximus tells them if you're lying.

There's a pilot program where they deem you eligible by just looking at Maximus and don't bother you with forms, but that's new. Maximus tells them every few months, so they'll know if you have too many assets much faster and remove you before your recertification date if that happens.

[crystal626]

---

@AndrewF wrote:

---

@Thomas_Thumb wrote:

---

@bs1234 wrote:

When I was signing up at the end of 2025, Part D program costs in my area varied hugely (and of course there weren't many of them now!)

Since I take some very expensive drugs ($20K per fill) it made sense to go with the cheapest that covered it, which was only $8.95.   The first fill then hits the cap ($2100) and all other covered meds are free.   Other plans were $200 a month and, in my case, for no gain.

---

I use Wellcare value script. Monthly premiums were $0 in 2025 but $9.60 in 2026. 

I also take some expensive meds. Reached the $2100 cap with June refills this year. A couple meds dropped over 70% in cost extending time to hitting cap. Last year reached the $2000 cap with March refills.

The current cost killers for me are premiums: Medicare part B $202/mo, basic supplemental with riders and no copays $330/mo, and dental+vision $68/mo. That's $7200 a year just for premiums. Unfortunately, low cost Medicare Advantage plans are not a viable option due to limited acceptance and issues with coverage of procedures/treatments.

---

Value Script is still $0 in Illinois.

MSP is a pain in the butt because the State already knows how much is in your bank account because Maximus tells them, but it's like filing taxes.

Every year you have to complete recertification forms then Maximus tells them if you're lying.

There's a pilot program where they deem you eligible by just looking at Maximus and don't bother you with forms, but that's new. Maximus tells them every few months, so they'll know if you have too many assets much faster and remove you before your recertification date if that happens.

---

It would be great if all states automated that system instead of harrassing people for bank statements when they already know what's in the account.