The Federal Medicare Extra Help program also referred as the Medicare Low Income Subsidy (LIS) program, is for people with full Medicaid coverage as well as for people who are not on Medicaid but who have limited income. (See Medicare Extra Help / Low Income Subsidy (LIS)).
Medicare Low Income Subsidy (LIS) – 2021
Here are 2020 Low-Income Subsidy Copayments:
- Full Benefit Dual Eligibles Institutionalized or Receiving Home and Community-Based Services (HCBS): $0
- Full Benefit Dual Eligibles with Incomes <= 100% of Federal Poverty Level
- Generic/Preferred Drugs: $1.30
- Other: $4.00
- Above Catastrophic Limit: $0.00
- Full Benefit Dual with Incomes > 100% of Federal Poverty Level & Other Full-Subsidy Eligible Beneficiaries
- Deductible: $0
- Generic/Preferred Drugs: $3.70
- Other: $9.20
- Above Catastrophic Limit: $0.00
- Beneficiaries with QMB/SLMB/QI, SSI or applied an income below 135% FPL and resources below $9,360 (individuals, 2021) and below $14,800 (couples, 2021)
- Beneficiaries
- Deductible: $0
- Generic/Preferred Drugs: $3.70
- Other: $9.20
- Above Catastrophic Limit: $0.00
- Beneficiaries with income below 150% FPL and resources between $9,361 and $14,610 (individuals, 2021) or between $14,801 and $29,160 (couples, 2021)
- Deductible: $92.00
- Coinsurance to Initial Coverage Limit: 15%
- Generics Above Catastrophic Limit: $3.70
- Others Above Catastrophic Limit: $9.20
Extra Help, you will need to file an. Application for Extra Help with Medicare Prescription Drug Plan Costs (Form SSA-1020). Resources and Income. What is the resource limit? Extra Help, your resources must be limited to $14,790 for an individual or $29,520 for a married couple living together. Extra Help is a program to help people with limited income and resources pay Medicare prescription drug program costs, like premiums, deductibles, and coinsurance. If you get Extra Help but you’re not sure if you're paying the right amount, call your drug plan. Medicare Extra Help eligibility. You may qualify for the low-income subsidy available under Medicare Part D if: Your annual income and assets are below the eligibility thresholds. The Medicare Extra Help program eligibility limits may change from year to year. For the most up-to-date levels, visit Medicare.gov.
How to Apply?
To apply for Low Income Subsidy (LIS), complete the Social Security Application for Extra Help with Medicare Prescription Drug Plan Costs (SSA-1020).
Help With My Copay
You may do it one of three ways:
- Apply online at www.ssa.gov/extrahelp; or
- Call Social Security at 1-800-772-1213 to apply over the phone or to request an application; or
- Apply at your local Social Security office.
After you apply, Social Security will review the application and send you a letter informing whether you are qualified for Low Income Subsidy. Once you qualify, you can choose a Medicare Prescription Drug plan. If you do not select a plan, the Center for Medicare and Medicaid Services will do it for you. The sooner you join a plan, the sooner you begin receiving benefits.
To learn more, read Extra Help with Medicare Prescription Drug Plan Costs
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Extra Help Medicare Part D
Our federal government offers help with paying for your Part D drug plan expenses if you qualify based on income. This is called the Low-Income Subsidy. Anyone can apply for this at Social Security at any time, but help is awarded based on proving low-income and limited resources. You must have an annual income that falls below 150% of the Federal Poverty Level based on your household size.
Beneficiaries who qualify will receive assistance with paying their monthly Part D premiums, their annual Part D deductible, and also their co-payments for retail medications. There are different levels of qualification, and the subsidy level generally determines how much assistance you will get with premiums. Someone qualifying a full subsidy would have 100% of their Part D premium paid for, up to the benchmark allowed by Medicare for that year.
For example, if you get an award notice that says you have a full subsidy, and the benchmark for the year is $34, then you can choose any drug plan you like, and the LIS program will pay up to $34/month toward your premiums. Choosing a drug plan with a premium of $34 or less in that scenario would mean you pay nothing for your drug plan. Furthermore, you will pay no deductible if your plan has one, and your copays for medications are greatly reduced. If you think you may qualify, it is worth contacting Social Security for an application.
Applying for Extra Help is easy. Just complete Social Security’s Application for Extra Help with Medicare Prescription Drug Plan Costs (Form SSA-1020). Here’s how:
- Apply online at www.socialsecurity.gov/extrahelp;
- Call Social Security at 1-800-772-1213 (TTY 1-800-325-0778) to apply over the phone or to request an application; or
- Apply at your local Social Security office.
After you apply, Social Security will review your application and send a letter to you to let you know if you qualify for Extra Help. After you qualify, you can choose a Medicare prescription drug plan. If you do not select a plan, the Centers for Medicare & Medicaid Services will do it for you. The sooner you join a plan, the sooner you begin receiving benefits. If you aren’t eligible for Extra Help, you still may be able to enroll in a Medicare prescription drug plan.
| If you have Medicare and Medicaid and/or a Medicare Savings Program | |||
|---|---|---|---|
| You are enrolled in... | And your income is... | Then you get... | Your 2017 copays are... |
| Medicaid | Up to $1010 ($1,355 for couples) per month in 2017 | Full Extra Help $0 premium and deductible | $1.20 generic copay $3.70 brand-name copay No copay after $4,950 in out of pocket drug costs |
| Medicaid and/or the Medicare Savings Program | Above $1010 ($1,355 for couples) per month in 2017 | Full Extra Help $0 premium and deductible | $3.30 generic copay $8.25 brand-name copay No copay after $4,950 in out of pocket drug costs |
| If you have Medicare Only | |||
| And your income is... | And your assets are... | Then you can get... | Your 2017 copays are... |
| Up to $1,356 ($1,822 for couples) per month in 2017 | Up to $8,890 ($14,090 for couples) in 2017 | Full Extra Help $0 premium and deductible | $3.30 generic copay $8.25 brand-name copay No copay after $4,950 in out of pocket drug costs |
| Below $1,505 ($2,022 for couples) per month in 2017 And your income and/or assets are above Full Extra Help Limits | Up to $13,820 ($27,600 for couples) in 2017 And your income and/or assets are above Full Extra Help Limits | Partial Extra Help Premium depends on your income$82 deductible or the plan's standard deductible, whichever is cheaper. | 15% coinsurance or the plan copay, whichever is less After $4,950 in out of pocket drug costs, you pay $3.30/generic and $8.25/brand-name or 5% of the drug cost, whichever is greater. |
How To Get Help With Copays
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Extra Help Copays 2019
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