The Low Income Subsidy (LIS) helps people with Medicare pay for prescription drugs, and lowers the costs of Medicare prescription drug coverage. This program is also know as "Extra Help" and "Part D Low-Income Subsidy".
If you are enrolled in Medi-Cal, Supplement Security Income, or a Medicare Savings Program, you will automatically qualify for extra help regardless of whether you meet the eligibility requirements. Medicare beneficiaries who are not a a part of this group can still apply. Read on to see how to qualify and apply.
If you qualify for Full Extra Health in 2023:
You will pay $0 Part D plan premium
You will pay $0 Part D plan deductible
You will pay up to $4.15 for each generic drug
You will pay up to $10.33 for each brand-name drug
Once your total drug costs (what both you and your plan pay for the drugs) reach $7,400, you will pay $0 for each covered drug.
Side note: If you get full Medi-Cal coverage and are in the Qualified Medicare Beneficiary program, you'll pay no more than $4.30 for each covered drug.
If you qualify for Partial Extra Help in 2023:
You will pay some or all of your Part D plan premium. This varies based on your income.
You will pay no more than $104 for your Part D plan deductible.
You will pay no more than 15% of the cost for each covered drug.
Once your total drug costs (what both you and your plan pay for the drugs) reach $7,400, you will pay:
You will pay up to $4.15 for each generic drug
You will pay up to $10.33 for each brand-name drug
Starting in 2024, the Low-Income Subsidy will no longer offer a partial extra help program. Instead, full benefits will be offered to people enrolled in Medicare who have limited resources. This means that those who qualify will have the majority, if not all out-of-pocket costs for prescription medications covered. They will have no deductible, no premium and fixed lower copays for certain medications.
LIS under Part D will be expanded to include beneficiaries who earn between 135% and 150% of the federal poverty level. For an individual, the 2023 yearly limit is $21,870. If enrollees meet resource limit requirements , they will receive the full LIS subsidies, which prior to 2024 were only available to beneficiaries making less than 135 percent federal poverty level.
In 2023, you can have no more than $16,600 as an individual in resources to qualify for Extra Help. These resources include:
Money in checking, savings or retirement accounts.
Stocks
Bond
The state does not count the following items as resources:
Your home
One car
Burial plat
Up to $1,500 for burial expenses if have put that money aside
Furniture
Other household and personal items
See if you qualify by going here, or if you need help and have questions, call Social Security at 1-800-772-1213.
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