Extra Help and Medicare Savings Programs in North Carolina

Extra Help: for prescription costs

Extra Help is the federal program that makes Part D affordable. If you qualify, it pays most of your drug plan premium, lowers or eliminates your deductible, and drops your copays to a few dollars per prescription. For someone taking several daily medications, the savings can be hundreds of dollars a month.

You apply through Social Security: online, by phone, or at a local office. The application asks about your income and resources, and Social Security decides if you qualify. Some people are enrolled automatically, including anyone on both Medicare and Medicaid, anyone receiving Supplemental Security Income, and anyone in a Medicare Savings Program. If you were auto-enrolled, you should have gotten a letter.

Medicare Savings Programs: for premiums and more

Medicare Savings Programs are the state side. North Carolina runs four levels, and which one you qualify for depends on your income. The basic level pays your Part B premium every month, which immediately puts that money back in your Social Security check. Higher levels can also cover your Part A and B deductibles, coinsurance, and copays.

You apply through your county Department of Social Services. In Guilford County, that means the Guilford County DSS office. In Forsyth County, the Forsyth County DSS. Every county in North Carolina has one, and the program rules are the same statewide. The income limits change each year, so check the current figures when you apply rather than relying on last year's numbers.

Why so many eligible people never apply

The estimates are striking. A large share of people who qualify for Extra Help never apply, often because they assume they earn too much or own too much. The resource limits are more generous than most people expect: your home, one car, and burial plots generally do not count. Income from a part-time job does not automatically disqualify you either.

The other barrier is the paperwork. The applications ask detailed financial questions, and that stops people cold. This is exactly what North Carolina SHIIP counselors do every day: sit with you, go through the forms line by line, and make sure nothing gets missed. It is free, it is unbiased, and they know these programs inside out. Here is the directory of free Medicare help in the Triad, including SHIIP.

How the two programs work together

They stack. Extra Help handles your drug costs. A Medicare Savings Program handles your Part B premium and possibly your medical cost sharing. Together, they can take someone from paying full Medicare costs to paying almost nothing. If your income is limited, apply for both. The applications are separate, the agencies are different, and neither one hurts your chances with the other.

One more thing worth knowing: qualifying for Extra Help also gives you a special enrollment period to change Part D plans outside the normal windows. If your drug needs change mid-year, you are not stuck waiting for fall. Annual Enrollment is still the best time to review everything at once.