Low Income Subsidy Help For Prescription Costs
Low Income Subsidy program helps pay for a portion of Part D prescription drug plan costs, including Part D premiums, deductibles, and copayments. Depending on your income and assets, you may qualify for a full or partial subsidy. The Social Security Administration and Centers for Medicare & Medicaid Services work together to administer LIS/Extra Help.
Online applications are available www.ssa.gov/ medicare/part-d-extra-help. There is a prescreen to see if you should proceed. Paper applications can be requested from the SSA to be sent by mail or a copy can be obtained at your local SSA office.
A decision letter will be mailed to the applicant upon determination of eligibility, usually within three weeks of a completed application.
Once found eligible, participants receive LIS for at least the remainder of the year.
If you qualify these benefits are also available:
• Access to prescription drug coverage
• Waiver for Part D late enrollment penalty
• Eligibility for several Special Enrollment Periods (SEP) as participants can change plans once during each of the first three quarters and again during the Annual Enrollment Period (Oct. 15 - Dec. 7)
• Potential auto-enrollment in Medicare Savings Programs (such as QMB, SLMB, and QI) You must satisfy three requirements or one special condition for eligibility:
• Have Medicare Part A and/or Part B
• Live within the U.S. (50 states or Washington D.C.)
• Meet additional eligibility criteria
• Receive some form of Medicaid (community or institutional), Supplemental Security Income or be enrolled in a Medicare Savings Program, such as QMB, SLMB, and QI.
Those receiving either Medicaid, SSI, or enrolled in a Medicare Savings Program do not need to apply for LIS as you should be automatically enrolled in LIS.
What does Full Help cover? Full Help covers those with lower incomes/fewer resources. Both the deductible and the plan premium for Part D are waived; for the premium to be waived, enrollment in a “benchmark” plan is required (meaning the plan is below the LIS premium amount). The benchmark in 2023 for Montana is $39.87.
People with full Extra Help will pay copays of between $1.45-$4.30 for generic drugs, and between $4.15-$10.35 for brand name drugs. After their total out-of-pocket drug expenses reach the catastrophic threshold ($7,400 in 2023), the beneficiary has no copays.
What does Partial Help cover? Partial Help covers those with slightly higher incomes/resources. The premium is either waived or an incomed-based sliding scale is used to determine benefits. The prescription drug plan has a $104 deductible, a 15% coinsurance (for covered drugs) and copays of $4.15 for generic medications and $10.35 for brand-name medications.
For more information, to see if you qualify or need assistance with your application, call your local SHIP counselor. To find your local SHIP counselor, call 800-5513191.