• You have Medicare Part A (Hospital Insurance) and/or Medicare Part B (Medical Insurance)
• You live in the United States
• You meet the income and resource limit

• Your income is how much money you make each year.
• Your resources are things of value that you own, like real estate, bank accounts and investments. Go to Medicare.gov for details on what counts in resources limits.

The income limit is based on your income from the previous year.

Income and resource limits in 2023:

In 2023, you could qualify for full or partial Extra Help benefits. Starting in 2024, partial beneficiaries will receive full benefits.

Full benefits

This helps people on Medicare and Medicaid.

• No monthly premium
• No deductible
• No more than $4.15 for generic drugs
• No more than $10.35 for brand name drugs

Partial benefits

People with higher incomes might get partial help like:

• Lower premiums
• Deductible no higher than $104
• Covered drugs cost 15% of costs

There are three ways to apply.

1. Apply online at Social Security.
2. Apply over the phone by calling Social Security at 1-800-772-1213 ,TTY 1-800-325-07781-800-772-1213, TTY 1-800-325-0778. Available in most U.S. time zones Monday – Friday 8 a.m. – 7 p.m. in English and other languages.
3. Apply in person at your local Social Security Office.

After you apply, Social Security will review your application and send you a letter to let you know if you qualify for Extra Help. And, if you do, you can choose a Medicare Advantage Prescription Drug Plan. If you don't select a plan, the Centers for Medicare & Medicaid Services (CMS) will do it for you. The sooner you join a plan, the sooner you begin receiving benefits.

If you qualify for Extra Help but your plan hasn't been notified by CMS, you can show certain documents to your pharmacy and pay a lower copay.

To be eligible, you must:

• Have three or more of these ongoing or chronic health issues:
  • Asthma
  • Chronic Heart Failure (CHF)
  • Chronic Obstructive Pulmonary Disease (COPD)
  • Depression
  • Diabetes
  • End-Stage Renal Disease (ESRD)
  • High cholesterol
  • High blood pressure
  • Osteoporosis
• Take seven or more prescriptions, and
• Have spent $1,233.75 on medications in the past three months.

In 2024, some of the eligibility requirements will change. Starting on January 1, 2024, to be eligible, you must:

• Have three or more of these ongoing or chronic health issues:
  • Asthma
  • Chronic Heart Failure (CHF)
  • Chronic Obstructive Pulmonary Disease (COPD)
  • Depression
  • End-Stage Renal Disease (ESRD)
  • High cholesterol
• Take eight or more prescriptions, and
• Have spent $1,332.50 on medications in the past three months

Members in the Drug Management Program will be automatically enrolled.

You don’t have to do anything. You’ll be automatically enrolled if you’re eligible. We’ll send you a letter to notify you. Once you’re enrolled, you’ll get the yearly comprehensive medication review, which includes an updated medication list and safe drug disposal tips. You’ll also get quarterly targeted medication reviews (TMRs) that look for changes in the drugs you take that might need to be addressed with your prescriber. We’ll send your prescriber a fax with suggested changes if necessary. Your MTM pharmacist or other qualified provider will also follow up with you, if needed.

You don’t have to participate in the MTM program if you don’t want to, and the MTM program doesn’t impact your plan Part D benefits, copays, coverage, or providers and pharmacies that may be in your plan’s network. You can decline certain parts of the MTM program and still stay enrolled, too.

Here are some of the resources to help you prepare for your comprehensive medication review:

Blank medication List

Drug Disposal Information

Questions? Call CSS Health at 1-877-450-3710 ,TTY 7111-877-450-3710, TTY 711. They’re available Monday through Friday, 8:30 a.m. to 5 p.m. EST. Or give us a call at the number on the back of your Member ID card.