LIS – Low Income Subsidy – Extra Help

What help can I receive if I can’t afford all my Prescriptions?
What if I have too many assets or higher income?

Low Income Subsidy – Extra Help

The Low-Income Subsidy (LIS) program/extra 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 the full subsidy or a partial subsidy. All beneficiaries who qualify for the LIS program are permitted to change Part D plans once a month at anytime during the year. CA Health Care Advocates     The full Low-Income Subsidy (LIS) program covers the premium and deductible of benchmark plans, that meet the minimum standards.  This means you do not pay a premium or deductible if you receive the full LIS benefit and enroll in a benchmark plan. You are, however, still responsible for copayments of $3.70 to $9.20  for each covered prescription. CA Health Care Advocates

SSA.Gov  LIS/Extra Help

What help can I receive?

The Social Security Extra Help is estimated to be worth about $4,000 per yearPublication 10013 * To qualify for the Extra Help, a person must be receiving Medicare, have limited resources and income  (scroll down to view) and reside in one of the 50 States or the District of Columbia.

Medicare beneficiaries can qualify for Extra Help with their Medicare prescription drug plan costs. The Extra Help is estimated to be worth about $4,000 per year. To qualify for the Extra Help, a person must be receiving Medicare, have limited resources and income, and reside in one of the 50 States or the District of Columbia.

Here I am today, October 2020 rewriting this page to answer the question below for someone who has too much income & assets to qualify for extra help, what can they do?  I feel that the brochure on Medicare Rx Coverage, their extra help section really explains it IMHO the best, simplest and easiest way to understand.

how to get extra help

Here’s more assistance
Even if you have high assets & Income
Beyond Part D Rx

Assistance Programs from the Manufacturer
and Government Programs

Medication Assistance Tool.org  the Medicine Assistance Tool, matches patients like you with resources and cost-sharing programs that may help lower your out-of-pocket costs, whether or not you have insurance.  This tool includes Merck  

CA Health Care Advocates – Resources for Rx Drug Savings

Pan  Foundation.org
The Patient Access Network (PAN) Foundation is  dedicated to helping federally and commercially insured people living with life-threatening, chronic and rare diseases with the out-of-pocket costs for their prescribed medications. Partnering with generous donors, healthcare providers and pharmacies, PAN provides the underinsured population access to the healthcare treatments they need to best manage their conditions and focus on improving their quality of life.

search disease or medication

Pharmaceutical Assistance Program

pharmaceutical assistance program

 

Benefits Checkup.org

benefit checkup org

 

National Patient Advocate Foundation

National Organization for Rare Disorders

California Prescription Drug Discount Program
At Medi-Cal participating pharmacies, you can get prescription drugs at the Medi-Cal rate plus a $0.15 processing fee. This rate may be lower than the Part D rate. Payments may not apply toward your Part D cost-sharing. This program should not be used as a substitute for Medicare Part D. To receive benefits, show your Medicare card at Medi-Cal participating pharmacies   SB 393 2000

6 Hints to get help with Rx costs on Medicare.gov

california rx card.com

Glaxo Smith Kline Rx Assistance

pfizer rx pathways.com    Find Assistance That’s Right for You    Pfizer RxPathways connects eligible patients to a range of assistance programs that offer insurance support, co-pay help,* and medicines for free or at a savings.†  Enter the name of the medicine you’ve been prescribed. You can search one medicine at a time. Then answer a few questions to see which available program(s) may be right for you.

Humira  

MS Multiple Sclerosis  

Financial Assistance Programs

RxAssist.org    RxAssist can help you learn about ways to use pharmaceutical company programs and other resources to help reduce your medication costs. Look at our database and frequently asked questions to get started.

Coupons 

 

If one has Part D Rx, the manufacturers cannot help out with coupons.  One might consider dropping Part D or if you have Medicare Advantage Plan, finding one that doesn’t include Part D.  We CANNOT advise you to do this. It’s beyond our pay grade and we are mandated to tell you about the penalty if you don’t purchase Part D.  Scroll down for hints from one of our wholesalers on using coupons and not using your Part D Rx plan.

The intention for coupons is to steer patients away from cheaper generic alternatives and toward the brands that they produce. Experts estimate that brand drug manufacturers are spending between $3 billion and $6 billion annually on coupon programs. Anti-Kick Back and all. HHS Report Mfg safeguards might not prevent coupons for Part D Rx Legally, the use of drug co-pay cards and coupons by individuals with government funded health care and prescription drug benefits, such as Medicare and Medicaid, is prohibited by the federal anti-kickback statute.

(2) Whoever knowingly and willfully offers or pays any remuneration (including any kickback, bribe, or rebate) directly or indirectly, overtly or covertly, in cash or in kind to any person to induce such person—

(A) to refer an individual to a person for the furnishing or arranging for the furnishing of any item or service for which payment may be made in whole or in part under a Federal health care program, or SSA.gov

Here’s some hints from our wholesaler…

 

Coupons are allowed to be used in Medicare, but it is tricky. When a client uses a coupon, or a GoodRX or even the pharmacies billing costs (which are sometimes cheaper than the plan copay) the drug doesn’t get run through Medicare, it becomes a cash pay situation and it doesn’t go against the Medicare deductibles, donut hole,  etc.   So that is the negative.

I have many clients that have purchased drugs directly from the pharmacy to get a lower cost, and some that have used Good RX or even just googled their drugs and bought them online at a cheaper cost.

There are certain things that are much cheaper online, Progesterone is a big one that my female clients find cheaper online..

So, if the pharmacy will work with the client to help them find the lowest cost, there are alternatives for our Medicare clients. Not all pharmacies will do this however, so it is good to do some research on more expensive drugs to find alternative solutions.

Good Rx

goodrx.com/discount-card

We do not know who they are.  We are not endorsing them.  We’ve heard from some of our clients, who are happy with them.

 

good-rx-video

Los Angeles Times 9.17.2020 Good Rx going IPO - They can make $$$ since the Rx pricing system is so crazy

  1. What if you have $$$ from Sale of Home and are buying a new home?

     

     

    First, see our General Page on the Low Income Subsidy LIS we will try not to duplicate the same information.

    Your resources must be limited to$13,640 for an individual or $27,250 for a married couple living together. Resources include such things as bank accounts, stocks and bonds.
     
    We do not count your home, car or any life insurance policy as resources;
     
    Learn More⇒Publication # 10525 * State Manual Page 5 * NCOA.org *
    30.5 Spenddown 30.6 Family Size 30.7 Financial Requirements 30.8 Evaluating Resources 30.8.1 Resource Standards 30.8.2 Resource Exclusions 30.8.3 Determining Countable Resources 30.8.4 Funds Held in Financial Institution Accounts
     
    Q. What counts as income and resources?
     
    A. The extra help has special income rules, based on but not identical to the rules for the Supplemental Security Income (SSI) program; the rules for counting resources are, for the most part, the same as the standard SSI resource rules.
     
    Is there estate recovery?

     

    1031 Exchange? Nope, doesn’t apply to primary residence?
     
  2. Anonymous says:
    The “Extra Help” part of my disabled wife Linda’s Prescription Drug Plan PDP is a big deal to us.

     

     

    Not only does it cover the deductible, but the co-pays on Linda’s specialty drugs (Keppra, Lamictal) can be costly, and the extra help wipes this out.

    But, I have no idea what allows her to qualify for this, and I’d like to understand how to ensure she gets this benefit in the future?

     
    • Steve Shorr says:
      We just updated this page some, to make it more readable… Check the qualifications section above and be sure to check the sources we cited. Please note that the numbers may change annually and with inflation.
       
  3. Anonymous says:
    I have income from wages. Does that count in full or do I get a break?
     

Links  &  Resources

My Advocate Helps Save money, engage with your community, and improve your health. Take advantage of the different programs in your area. My advocate makes it easy to find programs that fit your life.

CA Health Advocates.org on LIS/Extra Help

Hi Cap Medicare Counseling ca health advocates.org/hicap/

Federal Poverty Level Chart

4 Ways to Help Lower your Medicare Prescription Drug Costs # 11417

LA Times 8.10.2014 Tips to save $$$

Jewish Free Loan Assoc.

7 comments on “Part D Rx Low Income Subsidy – LIS – Extra Help

  1. I just used Medicare’s Rx Shopping Guide and I still have to pay almost $5,000 in premiums and co-pay for my medications for M S Multiple Sclerosis.

    What can I do to lower that???

    My husband and I earn around $35k and have way too many assets.

    Here’s the list of Rx that I take.
    list of rx

    Here’s the printout from Medicare.Gov on what the monthly Rx costs are, Donut Hole etc. This was the LOWEST cost plan!!!
    https://steveshorr.com/steveshorr/medi_gap_medicare_advantage/pdf_s/10-15-2020-SilverScript%20SmartRx%20%28PDP%29.pdf

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