It builds on the expansion of benefits in President Biden’s Low Cost Prescription Drugs Act
Today, the Biden-Harris administration announces new tools to reduce prescription drug costs for low-income individuals with Medicare through the Extra Help program, which provides eligible seniors and individuals with disabilities with help paying Medicare Part premiums. D and cost sharing. These resources complement upcoming expansions of Extra Help benefits and will ensure that more people who are eligible for benefits are enrolled in this vital program.
In August 2022, President Biden signed the Inflation Reduction Act into law, one of the most consequential health care laws since the Affordable Care Act (ACA). Among several policies intended to reduce the cost of prescription drugs, the law extends eligibility for the full low-income benefit known as the Extra Help program to individuals with limited resources and incomes up to 150 percent of the federal poverty level, or $21,870 annually in 2023 for majority of people, who meet eligibility criteria.
Starting January 1, 2024, eligible seniors and people with disabilities will benefit even more through the expansion of the Extra Help program. Nearly 300,000 low-income individuals with Medicare currently enrolled in the Extra Help program will benefit from the program’s expansion.1 People with extra help currently on partial benefits who will be eligible for full benefits again will pay no deductibles, no premiums, fixed lower payments for certain drugs, and could save nearly $300 a year, on average, according to estimates.
Up to 3 million seniors and people with disabilities could benefit from the Extra Help program now but are not currently enrolled. The expansion of the Extra Help program provides an important opportunity for those who could benefit from the lower-cost rewards, deductibles and co-pays programs now and when the program expands in 2024.
Therefore, the Department of Health and Human Services (HHS), through the Community Living Administration (ACL) and the Centers for Medicare and Medicaid Services (CMS), is announcing actions to reach eligible older adults and individuals with disability and enhance Extra Help enrollment as follows:
- ACL is announcing targeted efforts, informed by a comprehensive equity analysis, to reach, screen and enroll people in the Extra Help program, specifically focused on Americans living in rural and underserved communities. These efforts will leverage data made available by CMS and will involve ongoing technical assistance to beneficiaries of the Medicare Improvement for Patients and Providers Act (MIPPA) program, the State Health Assistance Program (SHIP), and other ACL beneficiaries working with communities .
- CMS is releasing new nationwide data on people with Medicare Part D prescription drug coverage living in the community who are currently receiving Extra Help, those expected to save the most on prescription drug costs as programs expand in 2024, and those likely eligible for Extra Help but not enrolled. This dataset includes key demographic information such as age, gender, race and ethnicity, marital status, living alone, metro status, limited English proficiency, disability status, and other community characteristics.
- CMS is making available an awareness toolkit for beneficiary advocates and community-based organizations to raise awareness of the benefits of Extra Help programs and how to join, including social media content and a user-friendly article, and will encourage drug plans to help eligible people enroll in Extra Help.
- Additionally, CMS will continue to:
- Educate partners and advocates through the National Medicare Education Program.
- Train SHIP consultants, agents and brokers through annual Open Enrollment training.
- Include information about Extra Help in the Medicare & You handbook, which is sent to more than 60 million people with Medicare each year.
- Remind people with Medicare of Extra Help through email and social media.
- Train 1-800-MEDICARE call center representatives to provide callers with information about Extra Help.
These actions build on a targeted outreach to 1.2 million older and disabled people by the Social Security Administration (SSA) to reach people who may be eligible for Extra Help and Medicare Savings Programs (MSP) with information about how to enroll in programs, as well as a targeted mailing by CMS about the extended benefits of the Extra Help programs. Through MSPs, low-income people with Medicare enjoy cost savings because their premiums and, in some cases, cost sharing are covered free of charge by Medicaid. Additionally, these efforts build on CMS’s proposed policies to simplify and rationalize MSP enrollment for low-income seniors and people with disabilities. CMS is committed to cutting red tape to ensure that the application, verification, enrollment and renewal processes for MSPs are less burdensome for people.
Get help with health care coverage and costs:
- More information about the Extra Help program is available at www.Medicare.gov/ExtraHelp. To enroll in the Extra Help program, visit SSA online at www.ssa.gov/extrahelp or call 1-800-772-1213.
- For one-on-one assistance with Extra Help, MSP, or other Medicare questions, contact your Medicare Insurance Plan (SHIP) at www.shiphelp.org/ or call 1-877-839-2675 to get the number for your local SHIP. Alternatively, call 1-800-MEDICARE (1-800-633-4227) for assistance. TTY users can call 1-877-486-2048. Learn more about other benefits available in your area at benefitscheckup.org.
- During the height of the pandemic, the Medicaid eligibility determination process was suspended to ensure low-income Americans did not lose access to critical care during the public health emergency. Medicaid restatements are now starting again in states across the country. If you are currently enrolled in Medicaid, make sure your information with the state is up to date.
Reducing Healthcare Costs and Expanding Coverage:
The Biden-Harris administration has made expanding access to high-quality, affordable health care a top priority, and with the Inflation Reduction Act, millions of Americans will see lower health care costs and of prescription drugs. In addition to expanding Extra Help benefits, key provisions of the Inflation Reduction Act include:
- Limit a month’s supply of each covered insulin to $35 for people with Medicare;
- Make recommended vaccines available free of charge to people with Medicare prescription drug coverage;
- Eliminate catastrophic cost sharing and limit annual out-of-pocket drug costs for prescription drugs for people on Medicare Part D starting in 2024;
- Enable Medicare to negotiate better prescription drug prices;
- Requiring drug companies to pay Medicare a discount if they raise their prices faster than inflation; AND
- Continue to improve premium tax credits that helped 13 million people covered by the ACA average $800 on their Marketplace health insurance in 2022.
1This figure is the most up-to-date data from the 2023 Medicare enrollment data, available at https://data.cms.gov/summary-statistics-on-beneficiary-enrollment/medicare-and-medicaid-reports/medicare-monthly- enrollments. The new demographics referenced later in this factsheet use 2021 data from the Medicare Current Beneficiary Survey.
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