Medicare Extra Help & Low Income Subsidy | Medicare Plan Finder

Are All Your Drugs Covered? Find out if you qualify for Medicare Extra Help.


Medicare Extra Help for Prescription Drugs

Have you heard of LIS (Low Income Subsidies)? You may have heard it referred to as “Extra Help.” It’s a federal program that helps seniors & medicare eligibles save money on their prescription drugs, and thousands of eligibles don’t even know about it. On average, seniors & medicare eligibles with LIS save almost $4,000 per year on prescription drugs. Are you eligible?

What does Medicare Extra Help Cover?

The Medicare Extra Help Program, or LIS, helps cover your prescription drug premiums, deductibles, coinsurance, and copayments. By qualifying for Medicare Extra Help, you will also qualify for a Special Enrollment Period. That means that you will have the ability to make changes to your Medicare coverage during any month of the year instead of having to wait until the Annual Enrollment Period like everyone else.

Even better, LIS provides coverage in the Donut Hole.

Inside the Medicare Donut Hole

The Donut Hole is a coverage gap that almost every Medicare beneficiary will face. It means that once you spend $3,750 on prescription drugs, you enter a coverage gap known as the Donut Hole. While you’re in that gap, you have less coverage than you did before. Typically, instead of paying 20% of your drug costs, you’ll have to pay 40% for generic drugs and 60% for brand-name drugs. The coverage gap will end once you spend $5,000 on prescription drugs, but that extra $1,250 can be detrimental. LIS can protect you in that gap.

Medicare Donut Hole | Medicare Extra Help

Medicare Low-Income Subsidy Chart and Eligibility

If you already have Supplemental Security Income (SSI) or if you have both Medicare and Medicaid, you will automatically qualify for Medicare Extra Help (low income subsidies). Otherwise, to be eligible for Medicare low income subsidies, you must:

  • Have Medicare Part A (hospital coverage) and Part B (medical coverage).

  • Have some form of prescription drug coverage (either Medicare Part D or Medicare Advantage with prescription drug benefits).

  • Be an American citizen.

  • Your savings, investments, and real estate do not value more than $28,150 if you are married or $14,100 if you are single.

The low income subsidy income requirements are as follows:

Low Income Subsidy Income Requirements Chart | Medicare Plan Finder

Medicare Extra Help Color Qualifications

Each year, certain Medicare participants will receive a letter from the Centers for Medicare and Medicaid Services (CMS). Some of these letters can directly affect your benefits, so it’s important to open them and respond immediately if required.

Purple: You automatically qualify for Medicare Extra Help because you:

  • receive Medicare and Medicaid
  • are enrolled in a Medicare Savings program
  • or receive Supplemental Security Income (SSI) benefits

Green: You are automatically enrolled in a Medicare Low Income Subsidy program because you:

  • receive Supplemental Security Income (SSI) benefits
  • are enrolled in a Medicare Savings Program
  • or applied for Medicare Extra Help yourself

Yellow: You qualify for Medicare and Medicaid and are enrolled in Original Medicare. Medicare will enroll you in a prescription drug plan unless you purchase your own plan or choose to decline.

Orange: You still qualify, but your copayments will change next year.

Gray: You no longer qualify but are encouraged to apply for the following year.

Medicare Extra Help Color Qualifications | Medicare Plan Finder

Medicare Extra Help Application

Visit the Social Security Administration website to complete the Medicare Extra Help Application.

Not sure if you’re eligible? Give us a call and we may be able to help. We can find an agent in your area to help you fill out your application (at no cost to you) and answer all your questions about Medicare and prescription drug coverage.

To get started, give us a call at 833-438-3676.

Have questions? Ask a Benefits Advisor!