Who Qualifies Low-Income Subsidy? (Solution found)

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 level of income is considered low income?

  • In the United States, low income refers to individuals or families that are earning a total of less than two times the federal poverty level. Low income uses family size and the total annual income of all working household members to determine eligibility.

What are the different levels of low income subsidy?

There are 2 levels of Extra Help: full subsidy and partial subsidy.

What are characteristics of low income subsidy?

Medicare beneficiaries receiving the low-income subsidy (LIS) get assistance in paying for their Part D monthly premium, annual deductible, coinsurance, and copayments.

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.

What are the income levels 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.

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.

Who automatically qualifies for extra help?

You should apply for Extra Help if: Your yearly income is $19,140 or less for an individual or $25,860 or less for a married couple living together. Even if your yearly income is higher, you still may qualify if you or your spouse meet one of these conditions: – You support other family members who live with you.

How are formularies established?

A drug formulary is a list of generic and brand-name prescription drugs covered by a health plan. The health plan generally creates this list by forming a pharmacy and therapeutics committee consisting of pharmacists and physicians from various medical specialties.

Can a consumer who qualifies for low income subsidy receive financial assistance quizlet?

Can a consumer who qualifies for Low Income Subsidy receive financial assistance for their part of Medicare Part D costs? Underwriting is required if the consumer is not in their Medicare Supplement Open Enrollment period or does not meet Guaranteed Issue criteria.

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 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.

What is the 4900 Medicare subsidy?

According to the Social Security Administration (SSA), Extra Help is estimated to be worth about $,4,900 a year. Those who qualify get either “partial” or “full” Extra Help; the amount of financial assistance you may receive will vary depending on your income and asset levels.

What are the income limits for Extra Help with Medicare 2021?

What Are the Income and Resource Limits for Extra Help in 2021? In 2021, the annual income limit for Extra Help for an individual is $19,140. For a married couple who is living together, the limit is $25,860.

What is the asset limit for extra help in 2022?

To get extra help in 2022, your total resources must be no more than to $14,010* for an individual ($27,950* for a married couple living together). *These limits do not include the $1,500 per person burial exclusion, see more details below.

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 maximum income to qualify for Medicare?

To qualify, your monthly income cannot be higher than $1,357 for an individual or $1,823 for a married couple. Your resource limits are $7,280 for one person and $10,930 for a married couple. A Specified Low-Income Medicare Beneficiary (SLMB) policy helps pay your Medicare Part B premium.

Limited Income and Resources

In addition, the Biden administration released new data on the estimated impact of enhanced subsidies under the American Rescue Plan, which was contained in a fact sheet from the Department of Health and Human Services (HHS) and analyses from the Office of the Assistant Secretary for Planning and Evaluation. Prior studies concluded that increased subsidies would result in considerable reductions in premium payments for people who purchase individual health insurance. This includes many of the over 15 million uninsured people who are now eligible to purchase coverage through the marketplace, as well as the nearly 14 million people who are currently enrolled in the individual market.

According to the Biden administration, an additional 3.6 million uninsured Americans will become eligible for ACA subsidies as a result of the American Rescue Plan.

The fact sheet also includes some instances of how uninsured individuals might save money under the new law: for example, an uninsured couple earning more than $70,000 per year could save more than $1,000 per month on premiums under the new law.

For the same or lower premium as their current coverage, many HealthCare.gov subscribers can upgrade to a higher metal level plan (with reduced out-of-pocket expenditures).

This is in contrast to the situation prior to the American Rescue Plan, when 69 percent of participants could find a plan for $10 per month or less and just 14 percent could obtain a silver plan for $10 per month or less.

For example, an individual earning $19,000 will be able to enroll in premium-free coverage and save an average of $66 per month.

Under the American Rescue Plan, the number of uninsured Latinos (730,000), Black and African Americans (360,000), Asian, Native Hawaiian and Pacific Islanders (197,000), and American Indians and Alaska Natives (48,000) who will be newly eligible for marketplace savings is detailed in a Department of Health and Human Services fact sheet.

The data sheet also offers estimates of the number of uninsured persons who will be eligible for $0 rates for silver marketplace coverage in each of these locations.

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.

  • Existing LIS users that require assistance in maintaining their LIS or understanding that their LIS is evolving fall into four categories. Every time there is a change to their LIS, we give them tailored alerts on colored paper. 1. Individuals who will no longer be automatically eligible for the LISEach September, we issue anotice (CMS Publication No. 11198) (PDF) on gray paper to individuals who will no longer be automatically eligible for the LISE. 2. This notification is an application for the LIS, and it comes with a pre-addressed, postage-paid envelope for submission. These individuals may still be eligible for the LIS program
  • However, they will need to submit a new application to the program’s administration. Gray Notice: The following is the gray notice:

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.

  • Meet the requirements to get the full (100 percent) premium subsidy
  • Are enrolled in a prescription medication plan where the premium is being raised over the low-income premium amount
  • CMS automatically enrolled them in their existing plan

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)
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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.

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

It is possible to receive assistance with Medicare Part D expenditures, such as premiums, deductibles, copayments, and other prescription drug costs, under the Low-Income Subsidy program. If you qualify for the Low-Income Subsidy in 2019, for example, you will not be required to pay more than $3.40 for a qualified generic prescription medicine or $8.50 for a covered brand-name prescription medication. In accordance with the Social Security Administration (SSA), Extra Help is worth around $4,900 per year, according to estimates.

Those who meet the criteria will get either “partial” or “full” support; the amount of financial assistance you will receive will vary based on your income and asset levels.

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:

  • However, even if your yearly income and countable resources exceed the amounts specified, you may still be eligible for the Low-Income Subsidy under certain circumstances. Among other things, while determining your eligibility for the Medicare Low-Income Subsidy, the following conditions are taken into account:

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. Was this article of assistance? Thank you for taking the time to provide feedback!

Need help?

Important: Even if you are not qualified for the Extra Help program in one year, you can still reapply in the next year if your income levels have changed. Is there anything else you would want to know about the Low-Income Subsidy program? We can connect you with a registered eHealth insurance advisor who can assist you in identifying Medicare plan alternatives that might lower your prescription medication expenditures. By entering your zip code in the box on this page, you may compare Medicare prescription medication coverage at your leisure.

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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. LIS Resource Capacity in 2022

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.

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

Part B premium is paid for you by an SLMB. North Carolina calls it a MQB-B, Nebraska calls it a QMB, and Oregon calls it an SMB. There are fewer benefits available under this program than under a QMB, and the income restrictions are also greater. Remember that the 2022 restrictions are not yet published, and this page will be updated as soon as they become available. Limitations on SLMB resources as well as monthly income in 2021

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. Limits on QDWI resources and monthly income in 2021

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.

As an added bonus, you’ll be eligible for Extra Assistance.

How to Get Help with Medicare Low-Income Subsidies

Individuals over the age of 65 who are blind or handicapped may qualify for Supplemental Security Income (SSI) payments, which are distinct from Social Security retirement benefits. SSI is not funded by Social Security taxes. His financing comes instead from general monies in the U.S. Treasury. To put it simply, SSI is intended to assist people in meeting their most basic need. Make advantage of theBenefit Eligibility Screening Tool to assess whether or not you are eligible for benefits. A web-based application is available for those who are impaired or blind.

Contact Social Security directly by calling the toll-free number provided on their website or visiting your nearest office.

Being Medicaid-eligible will entitle you to have your Medicare premiums paid for by your state.

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

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%
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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:

  • In addition, your yearly income and assets fall below the qualifying requirements. The qualifying requirements for the Medicare Extra Help program may change from year to year. Visit Medicare.gov for the most up-to-date information on coverage levels. Despite the fact that your yearly income exceeds the qualifying limit, you are responsible for the maintenance of additional family members who live in the same home
  • You live in Hawaii or Alaska

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.

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

Following the submission of your application, Social Security will analyze it and notify you by letter if you are eligible for assistance. It is possible to enroll in a Medicare Part D Prescription Drug Plan at that time if you qualify for Extra Help and are not already enrolled in a Medicare Part D Prescription Drug Plan. Everywhere you look, you’ll find Medicare-related information. Choosing which information to believe might be difficult.

eHealth’s Medicare-related material adheres to CMS requirements, ensuring that the information you get is accurate and that you are making the best decisions possible on your health insurance. Learn more about our Compliance Program by further reading.

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

  • It is important to note that the prices indicated above do not include any Medicare Part B premiums that you may be responsible for paying.

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:

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

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

  • A bill from a business or organization (like a nursing home). Alternatively, a copy of a state document demonstrating that Medicaid covered your stay for at least one month
  • A printout from your state’s Medicaid system demonstrating that you were a resident of the facility for at least one month
  • A document from your state proving that you are eligible for Medicaid and that you are receiving home and community-based services

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.

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