What Is Low Income Subsidy? (Perfect answer)

What’s the Low Income Subsidy (LIS)? The Low Income Subsidy (LIS) helps people with Medicare pay for prescription drugs, and lowers the costs of Medicare prescription drug coverage.

  • The Low-Income Subsidy (LIS) is a Medicare program to help people with limited income and resources pay Medicare prescription drug program costs, like premiums, deductibles, and coinsurance. The Low-Income Subsidy (LIS) is also known as Extra Help. To qualify for LIS, your income and resources must be equal to or lower than these limits:

How does Medicare Low income subsidy work?

The low-income subsidy helps pay for some of Part D prescription drug plan costs. A person with both Medicare and full Medi-Cal benefits (no share of cost) receives the low income subsidy automatically. A customer with Medi-Cal with a share of cost (SOC) may qualify for LIS.

How many levels of low income subsidy are there?

This help is called the Low Income Subsidy or simply “Extra Help.” There are two levels of the Low Income Subsidy available: a full subsidy and a partial subsidy.

What is the income limit for extra help?

To qualify for Extra Help, your annual income must be limited to $19,320 for an individual or $26,130 for a married couple living together.

Who is eligible for LIS?

It is also known as the Part D Low-Income Subsidy (LIS). If your monthly income is up to $1,719 in 2022 ($2,309 for couples) and your assets are below specified limits, you may be eligible for Extra Help (see the Extra Help income and asset limit chart for details).

What is a full subsidy for Medicare?

The full low-income subsidy covers the premium and deductible of benchmark plans. This means if you receive the full LIS subsidy, you do not pay a premium or deductible if you enroll in a benchmark plan. You are, however, still responsible for copayments of $1.10-$6.30 for each covered medication.

Does Social Security count as income for extra help?

We do not count: You should contact Social Security at 1-800-772-1213 (TTY 1-800-325-0778) for other income exclusions.

What does subsidy eligible mean?

If you’re insured through your employer, or eligible for programs like Medicare or Medicaid, you’re covered. Either way, the good news is you may be able to get help paying for individual health insurance. This help is called a subsidy.

What is the difference between Lis and Medicaid?

The income limits for Medicaid vary from state to state. Contact your State Medical Assistance (Medicaid) office to see if you qualify. The Medicare Part D Extra Help or Low-Income Subsidy (LIS) program helps people with limited financial resources pay for their Medicare Part D prescription drug coverage.

What is the asset limit for extra help in 2021?

In 2021, if your income is limited to $19,320 for an individual ($26,130 for a married couple living together) AND your resources are limited to $14,790 for an individual ($29,520 for a married couple living together), you may qualify for Extra Help. Note: Income and resource limits may change each year.

Does Medicare check bank accounts?

Medicare will usually check your bank accounts, as well as your other assets, when you apply for financial assistance with Medicare costs. However, eligibility requirements and verification methods vary depending on what state you live in. Some states don’t have asset limits for Medicare savings programs.

What is the give back benefit?

The give-back benefit is another term for Part B premium reduction. This is when a Medicare Advantage plan reduces the amount you pay towards your Part B monthly premium.

How can I check my LIS status?

Use an LIS look-up tool in a carrier’s portal (if the carrier has one). Call the carrier and ask to confirm your client’s LIS eligibility. Call 1-800-Medicare (1-800-633-4227) and ask to confirm your client’s LIS eligibility.

What are lis levels?

There are two levels of LIS/Extra Help, full and partial, whose eligibility criteria are contained in this chart. The Social Security Administration (SSA) estimates that Extra Help has an average annual value of $5,000.

What does full LIS mean?

People who’ll be reassigned to a new plan Qualify for the full (100%) premium subsidy. Are in a prescription drug plan that’s raising the premium above the low-income premium amount.

Limited Income and Resources

Individuals with Medicare who qualify for the Low Income Subsidy (LIS) receive assistance in paying for prescription medications, and the costs of Medicare prescription drug coverage are reduced.

How can I help people get the LIS?

We collaborate with our partners to identify and enroll individuals who may be eligible for the LIS, and we urge local groups to inform members of their communities about the program.

Who might need help with their LIS?

There are four types of persons who already have the LIS, but who may want some assistance in maintaining it or understanding that their LIS is evolving. When there are updates to their LIS, we send them customized alerts printed on colored paper to inform them of the changes. In September, we mail anotice (CMS Publication No. 11198) (PDF) on gray paper to those who will no longer be automatically eligible for the LIS, informing them that they would no longer be automatically eligible for the LIS.

These individuals may still be eligible for the LIS program, but they will be need to submit a new application.

  • Informs the individual as to why they are no longer automatically eligible for the LIS. Encourages them to complete and submit an application to the LIS program

2. Individuals who will see a reduction in their LIS co-payment During the first week of October, we mail anotice (CMS Publication No. 11199) (PDF) on orange paper to those who will be eligible for further assistance but will have a change in their co-payment. 3. Individuals who will be transferred to a new plan Beginning in early November, we will mail a notification on blue paper (CMS Publication No. 11208) (PDF) to individuals who are eligible for the LIS but will be switched to a different prescription drug plan beginning on January 1st, 2018.

  • 2. LIS co-payments will be adjusted for those who may be affected. In early October, we mail anotice (CMS Publication No. 11199) (PDF) on orange paper to those who will be eligible for more assistance, but their co-payment will be changed. Three. Individuals who will be transferred to another health-care strategy. People who qualify for the LIS but will be moved to a new prescription medication plan beginning on January 1st will get a notification on blue paper (CMS Publication No. 11208) (PDF) in early November. The following individuals are automatically reassigned:

LIS participants will also be reassigned automatically if their prescription drug plan departs the Medicare Program, providing they meet the eligibility requirements. 4. Individuals who made a decision on their plan We mail a notification (CMS Publication No. 11267) (PDF) to the following persons in early November:

  • Affected individuals’ premium costs will rise, but they won’t be automatically transferred to a new plan because they picked and enrolled in their current plan. People who are eligible to get the full (100 percent) premium subsidy, but who are in a plan that is raising their premium amount to the point where it is greater than the typical low-income premium subsidy level

This letter informs consumers about the rise in the cost of their prescription drug plan premiums and discusses their options for remaining in their current plan or switching to another plan (including plans for which they will not be required to pay a monthly premium).

Where can I learn more about the LIS?

  • Notices and mailings from the LIS
  • Consumer mailings (in PDF format)
  • Partners can benefit from the following information: Reassignment (PDF)
  • Medicare Limited Income NET Program
  • LIS Resource Limits Memo (PDF)
  • And more. What to Do If You Are No Longer Employed Fact Sheet Automatically qualify for additional assistance (this link will open in a new window)
  • Apply online for further assistance and receive more information from the Social Security Administration (which opens in a separate window)

Extra Help program: Medicare’s Part D Low-Income Subsidy

Publications from LIS; Consumer mailings (PDF); Publications from LIS. Reassignment (PDF); Medicare Limited Income NET Program; LIS Resource Limits Memo (PDF); and more topics are available to partners. When You No Longer Have a Job, Here’s What to Do Auto-qualify for more assistance (this link will open in a new tab). Apply online for additional assistance and receive more information from the Social Security Administration (which opens in a separate window); and

  1. Extra Help may be available to you if your monthly income is up to $1,719 in 2022 ($2,309 for couples) and yourAssetsAssets are resources such as savings and checking accounts, stocks and bonds, mutual funds, retirement accounts, and real estate”>assetsare below specified limits, such as those in a savings and checking account (see theExtra Help income and asset limit chartfor details). Among these restrictions is a $20 income disregard that theSocial Security Administration (SSA)The Social Security Administration is the United States government agency responsible for advancing the economic security of Americans through shaping and administering various programs, including Medicare, Social Security Disability Insurance (SSDI), Supplemental Security Income (SSI), and Extra Help. It is money that comes from sources other than your present job that is referred to as “unearned income.” Includes Social Security benefits, Veterans benefits, pensions, annuities, and other regular payments you get, such as alimony and workers’ compensation. “>unearned income is money that you receive without working for it (e.g., retirement income). Even if your income or assets exceed the qualifying criteria, you may still be eligible for Extra Help because certain types of income and assets, in addition to the $20 stated above, may not be considered against your eligibility
  2. “Medicaid is a state-run program that covers medical expenses for people with low or limited incomes. “>Medicaid, Supplemental Security Income (SSI), or a Medicare Savings Program (MSP), you are automatically eligible for Extra Help, regardless of whether you meet the program’s eligibility requirements. An orange-colored notification from the Centers for Medicare and Medicaid Services should arrive in the mail (CMS) Previously known as the Health Care Financing Administration (HCFA), the Centers for Medicare and Medicaid Services is the United States government agency responsible for administering Medicare, Medicaid, SCHIP (State Children’s Health Insurance Program), HIPPA (Health Insurance Portability and Accountability Act), CLIA (Clinical Laboratory Improvement Amendments), and a number of other health-related programs in the United States. “>A letter from the Centers for Medicare and Medicaid Services (CMS) telling you that you do not need to apply for further assistance

Advantages of Extra Assistance There are several advantages to participating in the Extra Help program (also known as the Part D Low-Income Subsidy):

  • It compensates you for your Part DPremium. A premium is the amount of money that a person must pay to Medicare or another health insurance plan in order to be covered by the plan. Premiums are often paid on a monthly basis.”>premium up to a benchmark amount determined by each state
  • Reduces the cost of your prescription medications. Special enrollment periods (SEP) are available once every calendar quarter throughout the first nine months of the year, allowing you to enroll in a Part D plan or transfer between plans without penalty. (You are unable to utilize the Extra Help SEP during the fourth calendar quarter of the calendar year) (October through December). Prescription changes should be made duringFall Open Enrollment, which is currently taking place. Prescription drug coverage changes
  • Eliminates any Part D late enrollment penaltyyou may have accrued if you delayed Part DEnrollmentEnrollment is the process of enrolling in Original Medicare, a Medicare Advantage Plan, or a Medicare private drug plan (Part D).”>prescriptiondrug coverage changes
  • And

Depending on your income and assets, you may be eligible for either full or partial Extra Help, depending on your situation. Both programs offer financial aid to help you pay for your medications. In order to qualify for such help, your drugs must be included on your plan’s formulary. Formulary This is the list of prescription pharmaceuticals for which a Medicare Advantage Plan that provides drug coverage—Medicare Advantage Prescription Drug Plan (MAPD)—or a Medicare private drug plan (Part D) will contribute to the cost.

You should include pharmacies in your plan’s formulary, and you should make advantage of them.

In most cases, managed care plan members can only obtain covered treatments from providers who are part of the plan’s network of providers.

It’s important to remember that Extra Help is neither a substitute for Part D or a strategy in and of itself: You must continue to have a Medicare Part D plan in order to get Medicare prescription medication coverage and Extra Help support from the government.

Making the decision to use Extra Help when you already have other kinds of prescription medication coverage For those who are eligible for Extra Help but already have other creditable prescription drug coverage, you should carefully consider the costs and coverage of Part D and Extra Help before deciding whether or not to enroll in Part D and Extra Help or to continue with your current prescription drug coverage.

It’s important to check with your previous employer or union to see whether you may enroll in a Part D plan without losing the retiree benefits you wish to preserve.

In the event that you are unable to maintain both Part D and your retiree benefits, or if maintaining both is no longer cost-effective, carefully consider whether you should enroll in a Part D plan, particularly if your retiree plan also includes your spouse or dependents.

Coverage that is commendable In the case of pre-existing conditions, creditable coverage is defined as any health insurance coverage you have within 63 days of obtaining a new insurance policy that can be utilized to reduce the waiting time for coverage.

To learn more about how to refuse Part D without losing your Medicaid coverage, contact your local Medicaid office now. For those who are still enrolled in Medicaid or who are qualified for Extra Help, they can enroll in Part D at any time without incurring any additional fees.

What Is the Low-Income Subsidy (LIS)?

People with low income and resources can get assistance from the Low-Income Subsidy (LIS), which is a Medicare program that helps them pay for Medicare prescription drug program costs such as premiums, deductibles, and coinsurance. The Low-Income Subsidy (LIS) is sometimes referred to as Extra Help in some circles. In order to be eligible for LIS, your income and resources must be equal to or less than the following amounts: Income and Resource Limits for the Low-Income Subsidy Program for 2019

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Monthly Income Limits Resource Limits* Amount ofPremium Subsidy
Level 1(Up to 135% of FPL) Single: $1,405Married: $1,902 Single: $7,730.01 to $12,890Married: $11,600.01 to $25,720 100%(less help with copaysdeductibles ifresources aremore than$7,560 or $12,600)
Level 2(136% to 140% of FPL) Single: $1,457Married: $1,973 Single: $12,890 or lessMarried: $25,720 or less 75%
Level 3(141% to 145% of FPL) Single: $1,509Married: $2,043 Single: $12,890 or lessMarried: $25,720 or less 50%
Level 4(146% to 150% of FPL) Single: $1,561Married: $2,114 Single: $12,890 or lessMarried: $25,720 or less 25%

LIS does not recognize money saved aside for funeral expenditures as part of your resources, which are limited to $1,500 for individuals and $3,000 for couples under the program’s guidelines.

Low-Income Subsidy – Medicare Extra Help Program

Beneficiaries who are eligible and have a low income may be eligible for a federal program that assists them in paying for Medicare Part D prescription medication costs. LIS recipients receive aid in paying their Part D monthly premium, yearly deductible, coinsurance, and copayments. They also receive assistance in paying for their Part B monthly premium. Additionally, those registered in the Extra Help program do not experience a gap in prescription medication coverage, sometimes known as the coverage gap or the “donut hole” in Medicare prescription drug coverage.

Medicare Extra Help eligibility

If any of the following apply to you, you may be eligible for the low-income discount provided by Medicare Part D:

  • According to Medicare Part D, you may be eligible for the low-income discount if you meet the following criteria:

The following are examples of assets that can be used to determine eligibility:

  • CASH and bank accounts, such as checking and savings accounts as well as certificates of deposit Outside of your home abode, you may own real estate. Stocks and bonds, including savings bonds issued by the United States
  • Mutual funds and Individual Retirement Accounts (IRAs)

If you qualify for the low-income subsidy, Medicare does not consider resources such as your house (or principal residence), insurance policies, or a car when determining your eligibility. Many people are eligible for Medicare Extra Help discounts but are unaware of their eligibility. The most effective approach to find out if you qualify is to submit an application.

How to apply for Medicare Extra Help

Simple fill out a “Application for Extra Help with Medicare Prescription Drug Plan Costs” (SSA-1020) with Social Security and submit it to them will qualify you for the Medicare low-income subsidy program. You can apply and submit this form using the following methods:

  • Applying online at Social Security
  • Calling Social Security at 1-800-772-1213 (TTY 1-800-325-0778) and requesting that an application be mailed to you
  • Or applying over the phone at 1-800-325-0778. Representatives from the Social Security Administration are accessible by phone Monday through Friday from 7 a.m. to 7 p.m. Visiting your local Social Security office and submitting your application in person

As soon as you submit your application, Social Security will analyze it and, if you are eligible, will give you a written notification in the mail. If you qualify for Extra Help but have not yet registered in a Medicare Part D Prescription Drug Plan, you will be able to do so at that time if you have not already done so. Medicare information may be found almost anywhere. What is difficult is determining which information may be relied upon.

Because eHealth’s Medicare-related content complies with CMS rules, you can be confident that you’re receiving reliable information that will help you make the best decisions possible regarding your health coverage. Continue reading to discover more about our Compliance Program.

Extra Help with Part D Costs for People with Low Income

Medicare Part D, or prescription drug coverage, was introduced in 2006 as part of the Medicare program. Additionally, Medicare offers additional assistance with the expense of prescription medications for individuals who are eligible. The Low-Income Subsidy (LIS) program is the name for this program.

Benefits of the Medicare Part D Extra Help/Low-Income Subsidy (LIS) Program

TheLow-Income Subsidy (LIS) program assists low-income individuals and families in paying a portion of their Part D prescription drug plan expenses, which include Part D premiums, deductibles, and copayments. In certain cases, you may be eligible for a complete subsidy, while in others, you may only be eligible for a half subsidy. For the first three quarters, all beneficiaries who qualify for the LIS program are entitled to change their Part D plans once a quarter, with the effective date of the change being the beginning of the next month.

There is also the option of making one modification in the last quarter of the year, with the new policy taking effect on January 1.

This section contains the following information:

How to Qualify for Extra Help/Low-Income Subsidy (LIS) with Part D Costs

If you qualify for Medi-Cal or a certain type ofMedicare Savings Program, you will be automatically enrolled in a prescription plan that participates in the Extra Help/Low-Income Subsidy (LIS) program for 2022. (Qualified Medicare Beneficiary, Specified Low-Income Medicare Beneficiary or Qualified Individual program). The table below describes how much you will pay for your Part D coverage based on whether you qualify for Medi-Cal and/or the Medicare Savings Program (MSP). This assumes that you are enrolled in a Benchmark plan.

You have… Your Assets Are at or Below… 1 You Pay
Medi-Cal without a Share of Cost (SOC). This includes theAgedDisabled Federal Poverty Level program (A D FPL).Medi-Cal with a SOC and your SOC is met in any one month. Single: $ 2,000Couple: $ 3,000Note:As of July 1, 2022, the resource limit will be $130,000 for an individual, and $65,000 for each additional family member.
  • There is no monthly fee, and there is no yearly deductible. Copayments of $1.35 each generic pill and $4.00 every brand-name pill
The above applies until the end of the year if SOC is met before July 1. If SOC is met between July 1 and Dec 31, Extra Help remains until Dec of following year. Note: If you have Medi-Cal and are living in a nursing home or are receiving Medi-Cal Home and Community Based Services (HCBS), you will have no drug copayments.
aMedicare Savings Program, such asQualified Medicare Beneficiary (QMB),Specified Low-Income Beneficiary (SLMB)orQualified Individual (QI)program.
  • There is no yearly deductible. Copayments of $3.95 for generics and $9.85 for brand names are required. There are no copayments for catastrophic coverage.

1The asset limit does not include the amount that can be used for burial expenditures, which is as follows: $1,500 for a single person; $3,000 for a couple. It should be noted that this $1,500 per person for funeral expenditures cannot be held in a bank account for the purposes of Medi-Cal. It has to be put into a burial insurance policy. In the event you do not satisfy the requirements outlined in the chart above, you may be eligible to apply for Extra Help/LIS through the Social Security Administration if you meet the requirements outlined in the table below.

Your Income Is Below… (Note: does not include the $20 disregard. Also, these are the 2021 figures. 2022 figures will come out by April 2022.) Your Assets Are at or Below 2 … You Pay
135% of the FPL:
  • Single: $1,449 per month, or $17,388 per year
  • Couple: $1,960 per month, or $23,517 per year
  • $1,449/month or $17,388/year
  • $1,960/month or $23,517/year for a couple.
  • Single: $1,449 per month, $17,388 per year
  • Couple: $1,960 per month, $23,517 per year
  • There is no monthly fee
  • $99 annual deductible
  • 15% coinsurance
  • Copayments up to $3.95/generic and $9.85/brand-name during catastrophic coverage
  • Single: $1,610 per month, or $19,320 per year
  • Couple: $2,178 per month, or $26,130 per year
  • Monthly premiums based on a sliding scale
  • A $99 yearly deductible
  • A 15 percent coinsurance rate
  • Copayments up to $3.95 for generic drugs and $9.85 for brand-name drugs under catastrophic coverage

1 If you qualify for Extra Help/LIS, you must also enroll in a Medicare Part D prescription medication coverage. 2The authorized amount for funeral expenditures is included in the asset limit: $1,500 for a single person; $3,000 for a couple. It should be noted that this exempt $1,500 per person for burial expenditures can be held in a bank account for LIS purposes.

Low-Income Subsidies and Medicare

If you are on Medicare and have a low income, you may be eligible for a subsidy to assist you in covering the expenses of medical treatment and prescriptions. Even if you do not meet the requirements for Medicaid, you may be eligible for one of these programs instead.

Despite this, if you qualify for Medicaid, you are immediately eligible for Extra Help because of your income. Here are some of the most often asked questions concerning low-income subsidy benefits and Medicare, which we have answered below.

Medicare and Low-Income Subsidy Eligibility

Being qualified for both Medicare and Medicaid is a possibility in some situations. Additionally, financial assistance is available via the Medicare Low-Income Subsidy Program (LIS). Extra Help is a program that aids with the expenses of Part Dprescription drug plans and is administered by the Department of Human Services. In addition, LIS participants are protected from the prescription drug coverage coverage gap (sometimes known as the donut hole).

How Do I Qualify for Medicare Low-Income Subsidy?

You must be a Medicare beneficiary with a modest income in order to be eligible. In addition, assets must be valued at less than a specific sum. Some persons may discover that they are disqualified for Medicaid, but that they are still eligible for the Low-Income Subsidy program. If you are qualified for any of the programs listed below, you may be eligible for a Low-Income Subsidy:

  • Qualified Medicare Beneficiary (QMB)
  • Specified Low-Income Medicare Beneficiary (SLMB)
  • Qualifying Individual (QI)
  • And Specified Low-Income Medicare Beneficiary (SLMB).

Otherwise, there are income and resource limitations. If your income and assets are in excess of the restrictions, but you believe you may still be eligible for a LIS, you should submit an application. Individuals with incomes up to $19,140 and married couples with incomes up to $25,860 are prohibited from applying. There are many degrees of support you may receive from a LIS, based on your specific requirements and needs. Depending on your assets, you may be eligible for some financial aid. For details on the restrictions, see the chart below.

Applicant(s) Resource Limit Resource Limitwith Burial Expenses
Individual (Full) $8,400 $9,900
Married Couple (Full) $12,600 $15,600
Individual (Partial) $14,010 $15,510
Married Couple (Partial) $27,950 $30,950

Applying for Medicare Low-Income Subsidy

Your eligibility for a Low-Income Subsidy will be determined by the Social Security Administration or your state Medicaid office. When your application is declined, you will be given an explanation as to why you are not eligible for consideration. After then, you have 10 days to make the necessary changes. Social Security will issue you a Notice of Award, which will describe the extent to which you are covered. The notice of denial will be sent if you do not fulfill the eligibility requirements.

You have the option of requesting a case review and submitting any additional material you believe is relevant.

If you are still dissatisfied with the decision, you can file an appeal with the Federal District Court.

Help with Medicare Premiums – QMB Program

If you’re having trouble making your insurance premium payments, you may consider applying for a QMB program. Keep in mind that in North Carolina, this program is referred to as MQB, and in Nebraska, it has been replaced by Medicaid. A QMB program covers your Part A and Part B premiums, as well as your yearly deductible for Part B and coinsurance and deductibles for Part A treatments. A QMB program also pays your Part A and Part B deductibles. Given that it is the most complete MSP now available, its income and resource restrictions are among the lowest in the industry.

Please keep in mind that the restrictions for 2021 are not yet available, and this information will be updated as soon as they become available. Resource and monthly income limits for the QMB in 2021

Applicant(s) Resource Limit Monthly Income Limit
Individual $7,970 $1,094
Married Couple $11,960 $1,472

Help with Part B Premium – SLMB Program

Your Part B premium is paid by an SLMB. In North Carolina, it is referred to as a MQB-B, in Nebraska as a QMB, and in Oregon as an SMB. This program provides fewer benefits than a QMB, and the income limitations are greater as a result. Please keep in mind that the 2022 restrictions are not yet available, and this material will be updated as soon as they become available. The SLMB Resource and Monthly Income Limits for 2021 are as follows:

Applicant(s) Resource Limit Monthly Income Limit
Individual $7,970 $1,308
Married Couple $11,960 $1,762

Annual Help with Part B Premium – QI Program

A QI program, like the SLMB program, will pay your Part B payment on your behalf. The distinction is that you can qualify for a QI program if you have a greater income, but you must apply for it every year, unlike other programs. If you obtained these benefits the previous year, you would be given first consideration for them this year. Please keep in mind that the name of this program varies from state to state, and that the restrictions for 2021 are not yet available; this material will be updated as soon as they are released.

Applicant(s) Resource Limit Monthly Income Limit
Individual $7,970 $1,469
Married Couple $11,960 $1,980

Help with Part A Premium for Working Beneficiaries Under 65 – QDWI Program

AQDWI is a program that is offered to handicapped people under the age of 65 who are employed. Part A premiums are covered by this program on a monthly basis. These programs have larger monthly income restrictions than the others, and their resource limits are the lowest of any of those available. With a QDWI, you do not immediately qualify for a LIS, unlike the other three MSPs listed above. Additionally, please keep in mind that the restrictions for 2021 are not yet available, and this information will be updated as soon as they become available.

Applicant(s) Resource Limit Monthly Income Limit
Individual $4,379 $4,379
Married Couple $5,892 $5,892

Part D Premium Benchmark Amounts and Low-Income Subsidies

Those who are eligible for a LIS should be aware of the premium baseline for Part Dprescription drug plans in their respective states. These financial amounts fluctuate from year to year. If you choose a plan with a monthly premium that is less than the benchmark amount for your state and you are eligible for a LIS, you should be able to enroll in the plan without having to pay a monthly payment to the insurance company. You will be required to pay the difference between your (higher) monthly premium and the benchmark premium amount if the monthly premium for the plan you choose exceeds the benchmark premium amount, as determined by your LIS.

Supplemental Security Income (SSI)

In contrast to Social Security retirement benefits, Supplemental Security Income (SSI) benefits are available to persons over the age of 65 who are blind or handicapped and have limited income and resources. Social Security taxes do not go toward funding Supplemental Security Income (SSI). Instead, it receives financing from the General Fund of the United States Treasury. In essence, SSI is intended to assist people in meeting their most basic requirements. Use theBenefit Eligibility Screening Tool to assess whether or not you are eligible for benefits.

If you are over the age of 65, you will be unable to apply online.

If you qualify for SSI, you will almost certainly be eligible for Medicaid in your state as well. Being Medicaid-eligible will entitle you to have your state pay for your Medicare premiums if you are so qualified. As an added bonus, you’ll be eligible for Extra Assistance.

How to Get Help with Medicare Low-Income Subsidies

If you qualify for any of the programs listed above, you will be able to save money on your Medicare premiums. If you’re looking for a prescription medication plan, we can assist you in finding the most appropriate option for your requirements. To find out more about the pricing in your region, call the number listed above. Alternatively, you may fill out our online rates form to view current local prices. If you know your zip code, you can find out what plans are available in your region. Select the Medicare plans that you’d like to compare in your area from the drop-down menu.

What is the low-income subsidy (LIS), also known as Extra Help?

Those with low income and assets can get financial assistance through the Medicare Part D program, which is known as Extra Help. The Extra Help program may be able to eliminate or greatly lower your Part D premiums as well as your deductibles and copayments if you are qualified. According to projections, almost one-third of all Medicare recipients will be eligible for the low-income subsidy. According to the Social Security Administration, this Extra Help might be worth an average of $5,000 per year on an annual basis.

  • Extra Help is only available to those who are enrolled in Medicare and have a restricted amount of income and assets.
  • In general, if your income is less than $19,320 for an individual and $26,130 for a pair, and your assets are less than $14,790 for an individual and $29,520 for a couple, including allowable funeral expenditures, you are eligible for some form of help.
  • Income tax refunds and housing aid are examples of types of income that do not count against the taxable amount.
  • Home and property ownership, family heirlooms, wedding or engagement rings, and life insurance policies do not qualify as assets under the IRS definition.
  • Even if your income and resources are significantly better than the average, you should still submit an application.
  • The Social Security Administration will send you a letter informing you whether or not you are eligible for Extra Help.

NCPSSM2021-11-23T00:22:43-04:00 Understanding the Extra Assistance with Your Medicare Drug PlanNCPSSM2021-11-23T00:22:43-04:00 Understanding the Extra Assistance with Your Medicare Drug Plan

Do I qualify for Medicare Part D Low-Income Subsidy?

Those who qualify for the Low-Income Subsidy, commonly known as Extra Help, can get assistance with their Medicare Part D prescription medication costs. Read on to learn more about how to qualify for the Low-Income Subsidy and how to submit an application for help.

How the Low-Income Subsidy helps with prescription drug costs

For individuals who qualify, the Low-Income Subsidy, also known as Extra Help, can assist them in covering the price of Medicare Part D prescription drugs. See if you qualify for the Low-Income Subsidy and how to submit an application for help.

Eligibility for the Low-Income Subsidy

It is determined if you are eligible for the Medicare Low-Income Subsidy based on your income and asset levels, which might fluctuate from year to year. To be eligible for Extra Help, you must meet the following requirements:

  • You must be enrolled in Medicare Parts A and B
  • And You must reside in one of the 50 states of the United States or the District of Columbia. Be self-sufficient with an annual income of $18, 735 or less (for individuals) or $25, 365 or less (for married couples living together)
  • Be in possession of resources totalling no more than $28,720 (for married couples living together) or no more than $14,390 (for individuals)

Types of income that affect eligibility for the Low-Income Subsidy

When determining whether or not you are qualified for the Low-Income Subsidy, the Social Security Administration considers several categories of income and resources. The following resources are included in the total:

  • Checking accounts, savings accounts, stocks and bonds are all examples of financial instruments. Real estate investments that are not limited to your house

Resources that are not included in the total:

  • The worth of a single residence
  • The value of a single automobile
  • Plot in a cemetery
  • Burial charges (up to $1,500 if you’ve saved aside money specifically for this reason)
  • Furniture and other objects of a domestic nature
  • A collection of personal things
  • Insurance coverage on one’s life
  • Social Security or Supplemental Security Income benefits that have been delayed

What if my income and resources exceed limits for the Low-Income Subsidy?

However, even if your yearly income and countable resources exceed the aforementioned restrictions, you may still be eligible for the Low-Income Subsidy under certain circumstances. Among other things, while assessing your eligibility for the Medicare Low-Income Subsidy, the following factors are taken into consideration:

  • You have earned income from your job. In Alaska or Hawaii, you are a resident. You provide financial assistance to other members of your family who reside with you.

If your income and resource levels above the eligibility criteria, but one of the conditions listed above applies to you, it may be worthwhile to make an application simply to be on the safe side and avoid being denied. Other inquiries concerning your eligibility for the Low-Income Subsidy can be answered by contacting Social Security directly (contact information below).

How to apply for the Low-Income Subsidy

You can apply for the Low-Income Subsidy through your state’s Medicaid program, or you can contact the Social Security Administration directly for further information (SSA). You can get in touch with Social Security by using the following methods:

  • Calling the toll-free number 1-800-772-1213. For those who utilize a TTY, dial 1-800-325-0778. Representatives are accessible Monday through Friday, from 7 a.m. to 7 p.m. in all time zones around the United States. Visiting a Social Security Administration office in person
  • Submitting an application online through the Social Security website

Important: Even if you are not qualified for the Extra Help program in one year, you may always reapply the next year if your income levels change. Is there anything else you would want to know about the Low-Income Subsidy? If you need assistance identifying Medicare plan alternatives that may be able to reduce your prescription medication expenditures, please contact us to talk with a professional eHealth insurance advisor. By entering your zip code in the box provided on this page, you may compare Medicare prescription medication coverage at your convenience.

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Low-Income Subsidy

When you qualify for the Low-Income Subsidy (LIS) Program, also known as Extra Help, you may be able to reduce your monthly premium by assisting with the payment of your Medicare Prescription Drug Plan costs.

2022 Low-Income Subsidy (Extra Help) Premiums

This table illustrates how much your monthly plan fee will be based on how much extra assistance you require. Both medical services and prescription medication coverage are included in the CHPW Medicare Advantagepremiums that are stated.

Your level of Extra Help MA DUAL PLAN (HMO SNP) MA PLAN 2 (HMO) MA PLAN 3 (HMO) MA PLAN 4 (HMO)
100% $0.00 $0.00 $27.50 $53.50
75% $10.10 $10.10 $37.60 $63.60
50% $20.20 $20.30 $47.80 $73.80
25% $30.30 $30.40 $57.90 $83.90

Please keep in mind that the prices shown above do not include any Medicare Part B premiums that you may be required to pay.

Learn More About Extra Help

  • State of Washington Office of the Insurance Commissioner
  • Social Security Administration (SSA)

How to Apply for Extra Help

Check to see whether you qualify by contacting the following:

  • Washington State Department of Social and Health Services: 1-800-737-0617 (TTY:711 or 1-800-833-6388)
  • Social Security: 1-800-772-1213 (TTY: 1-800-325-0778), 7:00 a.m. – 7:00 p.m., Monday through Friday
  • Washington State Department of Health and Human Services: 1-800-737-0617 (TTY:711 or 1-800-833-6388)

Best Available Evidence Requirement

When it comes to low-income subsidy (LIS), we can assist you if you feel you qualify but are paying the incorrect cost-sharing amount. We can provide the following services over the phone or in your local clinic:

  • Examine your qualifications
  • We will walk you through the process of acquiring documentation demonstrating your right co-payment amount. assist you in filling out the relevant paperwork

For assistance, call 1-800-942-0247 (TTY Relay: 711), Monday through Friday, from 8 a.m. to 8 p.m., seven days a week. Please see our Best Available Evidence (BAE) policy for more information. When determining a member’s Low-Income Subsidy, we follow the guidelines set out by the Centers for Medicare and Medicaid Services (CMS). The following types of evidence are acceptable:

  • Your state Medicaid identification card
  • Any other documentation from the state demonstrating that you are Medicaid eligible
  • And SSA letter stating the date on which your Supplemental Security Income (SSI) benefits became effective
  • A letter from the Social Security Administration stating that you are automatically qualified for Extra Help

Members who wish to contribute BAE documentation may do so as follows:

  • For help, write to:Community Health Plan of WashingtonAttn: Medicare Advantage1111 Third Avenue, Suite 400Seattle, WA 98101
  • Fax to 1-206-652-7050
  • Or call 1-800-942-0247 (TTY Relay: 711)

We will update our system as soon as one of the BAE documents is produced, allowing you to pay the right copayment when you pick up your next prescription at the pharmacy. CHPW Medicare Advantage is a health maintenance organization (HMO) with a Medicare contract. Enrollment in CHPW Medicare Advantage is contingent on the continuation of the contract. The benefit information supplied is a succinct summary rather than a comprehensive description of all available perks. Please contact us if you require further information.

Find your level of Extra Help (Part D)

Extra Help is a federally funded program that assists persons with limited income and resources in meeting the costs of the Medicare prescription medication program, such as premiums, deductibles, and coinsurance. A late enrollment penalty will not be charged if you qualify for Extra Help and enroll in a Medicare prescription medication plan. If you get Extra Help but are unsure whether or not you are paying the correct amount, contact your drug plan. It is possible that your plan will ask you to provide information to assist them in determining the degree of Extra Help you should receive.

Documentation

The following are examples of documentation that you can submit with your plan:

  • A purple note from Medicare stating that you are automatically eligible for Extra Assistance
  • A Medicare automatic enrollment notice in the form of a yellow card
  • Extra assistance in the form of a “Notice of Award” from Social Security
  • An orange notification from Medicare informing you that your copayment amount will change for the next year
  • If you haveA monthly payment paid by Social Security to persons with low income and resources who are handicapped, blind, or over the age of 65, you may be eligible for this benefit. Supplemental Security Income (SSI) payments are not the same as Social Security retirement or disability benefits.” role=”article” about=”/node/32531″> If you are eligible for Supplemental Security Income (SSI), you can use your Social Security award letter as proof that you are eligible for SSI.

You can also incorporate any of the papers listed below into your strategy. Any of these documents must be accepted as proof that you are eligible for Extra Help by your insurance company. If you don’t have or can’t find any of these documents, contact your insurance company for assistance.

Proof you have Medicaid and live in an institution or get home- and community-based services

  • Any of the documents listed below can be used to help you with your strategy, as well. Any of the documentation listed above must be accepted as proof that you qualify for Extra Help by your insurance company or plan. Request assistance from your plan if you do not have or cannot locate any of these documentation.

Other proof you have Medicaid

  • (If you have one, a copy of your Medicaid card will suffice.) a copy of a state-issued identification card proving that you are eligible for Medicaid
  • If you have Medicaid, you must provide a printout from your state’s computerized enrollment file
  • If you have Medicaid, a screen print from your state’s Medicaid system proving that you are eligible
  • Any other documentation from your state that demonstrates that you are eligible for Medicaid

Once you give your plan this information, your plan must:

  • Make certain that you do not spend more than the LIS medication coverage cost cap. Individuals enrolling in the program will have prescription expenses no more than $3.95 for each generic covered medicine and $9.85 for each brand-name covered drug in 2022. If you qualify for Medicare, please contact them so that we can confirm your eligibility if it is accessible. Depending on the conditions, it might take anything from a few days to as long as two weeks to process your request completely. Please contact us at 1-800-MEDICARE (1-800-633-4227). Toll-free: 1-877-486-2048
Note
Be sure to tell your plan how many days of medication you have left. Your plan and Medicare will work to process your request before you run out of medication, if possible.

Find out who to call about Medicare options, claims and more.

Individuals who have Part D prescription drug coverage who are on a fixed income may be eligible for financial assistance to cover the expenses of deductibles and co-pays, if they qualify. This additional assistance is sometimes referred to as the Low Income Subsidy (or LIS). Who is eligible to participate? Individuals who qualify for Extra Help must be qualified forMedicare Part D and have incomes that are less than 100 percent of the Federal Poverty Level for a full benefit or less than 150 percent of the Poverty Level for a partial benefit in order to get the assistance.

  1. Benefits are determined by the recipient’s income as well as his or her living condition.
  2. As well as the yearly deductible amount ($480 in 2022), it will cover the $99 deductible that partial subsidy applicants will be responsible for paying.
  3. Individuals will pay $3.95 for a generic or multi-source medicine and $9.85 for all other prescription prescriptions under the program.
  4. Individuals who are not eligible for Extra Help will continue to pay co-payments ranging from $3.95 for generic or multisource drugs with a retail price less than $79 to 5 percent for those with a retail price greater than $79.

Beneficiaries would pay $9.85 for brand-name pharmaceuticals with a retail price less than $197 and 5 percent for those with a retail price greater than $197 for brand-name drugs under consideration. Getting additional assistance with your Part D might be beneficial.

  1. Individuals who have Part D prescription drug coverage who are on a fixed income may be eligible for financial assistance to offset the expenses of deductibles and co-pays, depending on their circumstances. Additionally, the Low Income Subsidy is referred to as “additional help” (or LIS). Is there a limit on who may apply? Individuals who qualify for Extra Help must be qualified forMedicare Part D and have incomes that are less than 100 percent of the Federal Poverty Level for a full benefit or less than 150 percent of the Poverty Level for a partial benefit in order to receive the benefit. What are the advantages of using this kind of transportation? Benefits are determined by the recipient’s income as well as his or her living circumstances. A person’s monthly prescription plan premium for an Extra Help-approved plan will, in most cases, be paid for by the government. As well as the yearly deductible sum ($480 in 2022), it will cover the $99 deductible that partial subsidy applicants will have to pay out of pocket in addition. The Extra Help program will also cover all medications that fall within the coverage gap, often known as the doughnut hole, as well as 85 percent of prescription expenses for those who receive a partial subsidy from the government. For generic or multi-source pharmaceuticals, individuals will pay $3.95 per pill, and $9.85 per pill for all other medications. Individuals who are eligible for Extra Help will continue to pay co-payments ranging from $3.95 for generic or multisource drugs with a retail price under $79 to 5 percent for those with a retail price greater than $79. Individuals who are not eligible for Extra Help will pay co-payments ranging from $3.95 for generic or multisource drugs with a retail price less than $79 to 5 percent for those with a retail price greater than $79. Beneficiaries would pay $9.85 for brand-name pharmaceuticals with a retail price less than $197 and 5 percent for those with a retail price greater than $197 for brand-name drugs under the program. Assistance with your Part D requirements might be beneficial.

Extra Help is expected to save recipients an average of $5000 in prescription medication expenditures each year, according to estimates. The following are some examples of fluctuating benefits:

Beneficiaries Eligible Maximum Income(2021 Federal Poverty Levels) Maximum Resources(2021) Benefits (Deductibles, Co-pays, Out of pocket)
Institutionalized for more than 30 days in an assisted living, nursing home or hospital and receivingMedicaid. Deductibles and Co-pays$0.00
Non-institutionalized Income ≤ 100% Poverty $1,094/single $1,472/couple $9,470/single $14,960/couple Deductible- $0Premium in excess of $35.02 Generics- $1.35Name Brands- $4.00Out of pocket- $0
Non-institutionalized Income135% Poverty orMedicare Savings ProgramEnrollee $1,499/single $1,959/couple $9,470/single $14,960/couple Deductible- $0Premium in excess of $35.02 Generics- $3.95Name brands- $9.85Out of pocket- $0
Non-institutionalized (Partial Subsidy) Income ≤ 150% Poverty $1,595/single $2,155/couple $14,790/single $29,520/couple Deductible- $92.00Total out of pocket 15% (in doughnut hole) Generics after doughnut hole- $3.95Name brands after doughnut hole- $9.85

Individuals who receive Medicaid, Supplemental Security Income, or a Medicare Savings Program (Qualified Medicare Benefit – QMB, Qualified Individual 1 – QI-1, or Special Low Income Medicare Beneficiary – SLIM-B) on top of their Medicare benefits will be automatically enrolled in Extra Help. Auto-enrollees may be required by their county department of social services to provide proof of their legal presence, income, and financial means. Individuals who are not automatically registered must submit an application through the Social Security Administration, or they can enroll by phone through the Social Security Administration (1-800-772-1213).

Pathways to Extra Help – the Part D low income subsidy and how it can help your clients

There is a unique program known as the Low Income Subsidy (LIS) that assists with the cost sharing for Medicare Part D prescription drugs. LIS is often referred to as “Extra Assistance.” LIS is administered by the Social Security Administration; you do not submit an application through your Part D plan. See the graphic below from the Medicare Rights Center on Extra Help Income and Asset Limits. (The $20/month income disregard has already been deducted from the given amounts) (they update it annually)

Enrolling in Extra Help

There are three primary routes to admission into the LIS program: 1) By becoming a Medicaid recipient. All Medicaid participants, even those who fulfill the aspenddown requirement, are “deemed” into LIS (and so immediately registered by the Social Security Administration) and do not need to submit a separate application for Extra Help. Find out more about how getting Medicaid for only one month can qualify you for full Extra Help benefits for up to 18 months in the section below. 2) Enrolling in a Medicare Savings Program (Medicare Advantage Plan).

  1. The Medicare Savings Program in New York does not need any resource testing.) The Medicare Savings Program income guidelines are available on the website of the New York State Department of Health (www.health.state.ny.us).
  2. More information may be found in this article.
  3. Extra Help income restrictions are established at 150 percent of the federal poverty level, and there is an asset test.
  4. You may also discover information about Extra Help in a variety of other languages on the internet.
  5. You can apply for Extra Help and MSP at the same time through the Social Security Administration; SSA will submit the information from your Extra Help application to the New York State Department of Health, which will utilize the information to determine your eligibility for MSP benefits.

Individuals who apply for LIS through the SSA and are deemed ineligible are, of course, entitled to a written notification of their ineligibility as well as the ability to appeal.

Benefits of Extra Help

1) Assistance with cost-sharing for Medicare Part D With the Extra Help program, a subsidy is provided that covers the majority (but not all) of the beneficiary’s cost sharing responsibilities. Individuals receiving Extra Help do not need to be concerned about falling into the “donut hole” because the LIS subsidy will continue to cover them through the donut hole and into catastrophic coverage. LIS beneficiaries with incomes up to 135 percent of the federal poverty level (FPL) are generally eligible for “full” Extra Help, which means they pay no Part D deductible, no monthly premiums up to the benchmark amount, and fixed, relatively low co-pays (between $1.30 and $8.95 for 2020 depending on the person’s income level and the tier category of the drug; Medicaid beneficiaries in nursing homes, waiver programs, or managed long-term care pay no co-pays).

Beneficiaries who receive full Extra Help and reach the catastrophic coverage limit do not have to pay any co-pays.

Beneficiaries between 135 percent and 150 percent of the federal poverty level (FPL) are eligible for “partial” Extra Help, which reduces the Part D deductible to $89 (2020 figure- click here for updated chart); establishes sliding scale fees for monthly premiums; and limits co-pays to 15 percent, until the beneficiary reaches the catastrophic coverage limit, at which point co-pays are limited to a maximum of $8.95 (2020 figure- click here for current amount) or 5 percent of the drug 2) Enrollment in a Medicare Part D plan was made easier.

Extra Help beneficiaries who are not currently enrolled in a Part D plan and who do not choose to select a plan on their own will be automatically enrolled into a benchmark plan by the Centers for Medicare and Medicaid Services (CMS).

Nonetheless, one disadvantage of facilitated enrollment is that the plan may not be the best “fit” for the beneficiary if it does not cover all of his or her medications, assesses a higher tier level for covered drugs than other comparable plans, and/or requires the beneficiary to go through administrative hoops such as prior authorization, quantity limits, and/or step therapy.

  • Take a look at number 3 below.
  • Extra Help participants have a continuous special enrollment period, which means that they can switch plans at any time and are not “locked into” the yearly open enrollment period, as is the case for most other Americans (October 15-December 7).
  • Beginning in 2019, people eligible for Extra Help will no longer be able to enroll in classes on a continuous basis.
  • 4) There is no penalty for enrolling late.

How Long Does Extra Help Status Last?

The following are the requirements for “deemed” beneficiaries (Medicaid/Medicare Savings Program recipients): Extra Help status is valid for at least the remainder of the current calendar year, even if the individual loses his or her Medicaid or Medicare Savings Program coverage during that time period. Anyone receiving Medicaid or a Medicare Savings Program during any month between July and December retains their LIS status for the balance of that calendar year as well as the next year. The fact that an individual has Medicaid coverage for even a short amount of time (for example, completing a spenddown requirement for only one month) can assist to assure that the individual receives Extra Help coverage for at least six months, and perhaps as long as 18 months.

There are distinct criteria for utilizing past-due medical bills versus past-due medical expenses that have been paid.

In the event that a person loses their deemed status at the end of a calendar year because they no longer receive Medicaid or the Medicare Savings Program, the Social Security Administration (SSA) should notify them in advance and provide them with the opportunity to file an Extra Help application through the SSA.

There are no reporting requirements under the Extra Help program per se, but recipients must reply to the Social Security Administration’s request for redetermination.

What to do if the Part D plan doesn’t know that someone has Extra Help

There can be significant delays between the time a person is approved for Medicaid or a Medicare Savings Program and the time that information is formally sent to the Part D plan by CMS. Beneficiaries are frequently charged co-pays, premiums, and/or deductibles that they cannot afford and should not be required to pay as a result of this practice. In order to safeguard LIS beneficiaries, CMS has implemented a ” Best Available Evidence ” policy, which requires plans to accept alternate forms of proof of someone’s LIS status and adjust the person’s cost-sharing requirement in accordance with the alternative form of proof.

If the plan refuses to recognize the individual’s LIS status, the individual or their advocate should submit a complaint with the CMS regional office in their region.

The Centers for Medicare and Medicaid Services (CMS) also provides comprehensive advice on the LIS rules in Chapter 13 of its Medicare Prescription Drug Benefit Manual. The Empire Justice Center contributed to the writing of this article.

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