Beneficiaries with Medicare who have limited income and assets may qualify for Extra Help with the costs of their prescription drugs. This program is also known as LIS, or the Part D Low Income Subsidy. The Social Security Administration (SSA) and the Centers for Medicare & Medicaid Services (CMS) work together to provide the benefit.
Who qualifies for Extra Help?
Some people get Extra Help automatically. These include people who are enrolled in both Medicaid and Medicare (often called dual eligible), those receiving Supplemental Security Income (SSI), and those who qualify for a Medicare Savings Program. These individuals do not need to apply for the program, though they may still wish to consult a benefits counselor to determine the best Part D plan to suit their situation.
Anyone else who is not already enrolled in the benefits noted above must apply to Social Security to receive Extra Help. The income and asset requirements for 2018 are available in this chart. (2019 eligibility guidelines will be released in January/February following publication of the annual Federal Poverty Levels.)
Benefits of Extra Help
The amount of Extra Help a beneficiary receives depends on their income and resources. Beneficiaries will receive either a full-subsidy or a partial-subsidy. Be sure to review the Extra Help eligibility and coverage chart for details. Most people who qualify for Extra Help will pay:
- No premiums,
- No deductibles (unless receiving the partial subsidy), and
- No more than $8.35 in 2018 ($8.50 in 2019) for each drug their plan covers.
In addition to lower out-of-pocket costs, beneficiaries with Extra Help have the following protections:
- A quarterly Special Enrollment Period (one time every three months between January – September + once during Annual Open Enrollment) to join or switch Medicare Part D drug plans during the year. These opportunities allow people who get Extra Help to not wait for the Annual Open Enrollment Period (Oct. 15 – Dec. 7) to change plans. Any plan changes made outside the Annual Open Enrollment Period will become valid for the following month. This is especially helpful to seniors/adults with disabilities who may need to begin medications that are not on their current plan’s formulary (approved drug list).
- No Part D late enrollment penalty, even if the beneficiary enrolls late (that is, after they were first eligible to join a Part D plan and if they did not have other drug coverage).
Ways to apply for Extra Help
If you know a senior or adult living with a disability who may be eligible for Extra Help, direct them to the following:
- BenefitsCheckUp® has a direct link to submit Extra Help applications to the Social Security Administration. In addition, the free online screening tool will tell applicants if they likely appear eligible for other benefits that can help with health care and prescription costs.
- Their local State Health Insurance Assistance Program (SHIP). SHIPs are federally funded to provide free, objective assistance to people with Medicare and their families. SHIPs also can help with applications for Extra Help and the Medicare Savings Programs. To find your SHIP, call toll-free 877-839-2675 or visit the SHIP TA Center website.
- People with Medicare can also apply directly through the Social Security Administration.
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