Get Medicare Financial Assistance with the Medicare Extra Help Program

October 1, 2018

• Medicare

Did you know that Medicare offers financial assistance programs to those who cannot afford to pay their monthly premiums? The Medicare Extra Help program can help you afford your prescription drug plan.

What is a Low Income Subsidy?

LIS (Low Income Subsidies) is a federal program commonly referred to as Medicare Extra Help. It helps Medicare beneficiaries like you pay for prescription drugs. The program is designed to help those who do not qualify for Medicaid but still need financial assistance.

Medicare beneficiaries with LIS save an average of $3,900 per year on their prescription drugs. Therefore, beneficiaries might pay about $2 for a prescription instead of, say, $40.

What does Medicare Extra Help Cover?

The LIS program provides tremendous support for prescription drug coverage as long as you have a Medicare Part D drug plan or Medicare Advantage. LIS provides help with premiums, deductibles, coinsurance, and copayments. Also, LIS beneficiaries have a continuous SEP (Special Election Period) which means they can change plans or enroll any time of year! No more waiting for AEP (October 15 – December 7).

Additionally, LIS can help you pay for any late enrollment fees you may have. You might have a late fee if you wait too long to enroll in a Medicare prescription drug plan.

You will start by paying for 100% of your drug costs until you hit your deductible ($435 in 2020). Then, you will only pay a small percentage of your drug costs. Once you spend $4,020, you will pay 25% of brand-name drug costs and up to 25% of generic drug costs..

Medicare Extra Help Application

A senior or Medicare beneficiary is eligible for LIS at 150% of the Federal Poverty Level with (2017):

Income ($18,090/yr individual, $24,360/yr marital)

• Wages
• Social Security Income
• Annuities
• Family Support

Resources/Assets ($13,820 individual, $27,600 marital)

• Real Estate
• Stocks and bonds
• Mutual Funds
• Individual Retirement Accounts (IRAs)

If you think you may be eligible, click here to download the Medicare Extra Help application and get started. Send your completed Medicare Extra Help application to:

Social Security Administration
Wilkes-Barre Data Operations Center
P.O. Box 1020
Wilkes-Barre, PA 18767-9910

Medicare Savings Program

If you do not qualify for Low Income Subsidies, you may still qualify for another Medicare Savings Program. Much like LIS, Medicare Savings Programs help those who are not eligible for Medicaid but still need help paying for Medicare costs. Medicare Savings Programs have certain qualifications that include your monthly income and assets (stocks, bonds, savings accounts). The programs are as follows:

Qualified Medicare Beneficiary (QMB) Program:

Helps pay Part A premiums, Part B premiums, and deductibles, coinsurance, and copayments.

Qualification Limits:

• Married couple monthly income of $1,392 or less
• Married assets valuing $11,340 or less
• Individual assets valuing $7,560 or less
• Individual monthly income of $1,032 or less

Specified Low-Income Medicare Beneficiary (SLMB) Program:

Helps pay for Part B premiums

Qualification limits:

• Individual monthly income of $1,234 or less
• Married monthly income of $1,666 or less
• Individual assets valuing $7,560 or less
• Married assets valuing $11,340 or less

Qualifying Individual (QI) Program:

Helps pay for Part B premiums

Qualification limits:

• Individual monthly income of $1,386 or less
• Married monthly income of $1,872 or less
• Individual assets valuing $7,560 or less
• Monthly assets valuing $11,340 or less

Qualified Disabled and Working Individuals (QDWI) Program:

Helps pay for Part A premiums for those who are working, disabled, and under 65 or who returned to work and lost their premium-free Part A. This is not for those who are already receiving state medical assistance (Medicaid).

Qualification limits:

• Individual monthly income of $4,132 or less
• Married monthly income of $5,572 or less
• Individual assets valuing $4,000 or less
• Married assets valuing $6,000 or less

Social Security Help

If you receive social security benefits, you may be able to get a greater benefit by enrolling in certain Medicare plans. That’s right, some Medicare Advantage plans (offered by private carriers) include benefits that pay for part of your Part B premiums, which will result in you getting a slightly larger check from Social Security. Talk to a Medicare Plan Finder agent to see if this type of benefit is available to you.

Get Help Completing Your Medicare Extra Help Application

Some Medicare beneficiaries go years without realizing they qualify for Medicare Extra Help (LIS). Licensed agents in your area may be able to help you apply for LIS. If you haven’t already spoken to an agent about applying for LIS, call Medicare Plan Finder now at 844-431-1832 or click here to request a call.

This post was originally published on November 9, 2017, and updated on December 31, 2019.