CMS expands Extra Help program for savings on Medicare Part D premiums and cost-sharing
Expansion eligibility for the full low-income subsidy-benefit arrives as many are losing Medicaid coverage in the redetermination process.
Photo: Willie B. Thomas/Getty Images
Beginning January 1, 2024, eligible seniors and people with disabilities will be eligible for additional benefits to lower prescription drug costs through the expansion of the Extra Help program, according to the Department of Health and Human Services.
The Inflation Reduction Act included policies to lower the cost of prescription drugs. This included expanding the eligibility for the full low-income subsidy benefit, known as the Extra Help program, to individuals with limited resources and incomes up to 150% of the federal poverty level, or $21,870 per year in 2023 for most individuals, who meet eligibility criteria.
WHY THIS MATTERS
During the height of the pandemic, the eligibility determination process for Medicaid was put on pause to ensure low-income Americans did not lose access to critical care during the public health emergency, said the Centers for Medicare and Medicaid Services.
Medicaid redeterminations began in May and the public health emergency ended on May 11. More than half a million people who had Medicaid coverage have been disenrolled. Many of these individuals remain eligible for Medicaid coverage.
For those with Medicare coverage, nearly 300,000 low-income people enrolled in the Extra Help program stand to benefit from the program's expansion, according to CMS.
People with Extra Help currently with partial benefits who will be newly eligible for full benefits will pay no deductible, no premium and fixed lower copayments for certain medications, and could save nearly $300 per year, on average, according to CMS estimates.
Up to three million seniors and people with disabilities could benefit from the Extra Help program now but aren't currently enrolled.
THE LARGER TREND
These actions build on a targeted mailing to 1.2 million seniors and disabled people from the Social Security Administration to reach people who may be eligible for Extra Help and Medicare Savings Programs.
Through Medicare Savings Programs, low-income people with Medicare benefit from cost savings, as their premiums and, in some cases, cost-sharing, are covered through Medicaid at no cost.
Information will be Included in the Medicare & You handbook, which is sent each year to more than 60 million people with Medicare.
Through the Administration for Community Living, the Centers for Medicare and Medicaid Services will reach eligible seniors and people with disabilities to improve enrollment in Extra Help through efforts focused especially in rural and underserved communities.
These efforts will leverage data made available by CMS and involve ongoing technical assistance to grantees in the Medicare Improvement for Patients and Providers Act program, the State Health Insurance Assistance Program and other ACL grantees working with communities.
CMS said it is releasing new national data on people with Medicare Part D prescription drug coverage. This data set includes key demographic information such as age, gender, race and ethnicity, marital status, living alone, metro status, limited English proficiency and disability status.
Twitter: @SusanJMorse
Email the writer: SMorse@himss.org
