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. 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 $2.95-$7.40 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.

Apply for Extra Help With Medicare Prescription Drug Plan Costs

Trouble Paying Rx Prescription Drugs # 11318?  3 fold flyer

Understanding Extra Help Publication # 10508

Your Guide to Medicare Prescription Drug Coverage – Scroll down or it’s on your right, then go to page 74

Qualifications to get Extra Help

  • You have Medicare Part A (Hospital Insurance) and/or Medicare Part B (Medical Insurance); and
  • You live in one of the 50 States or the District of Columbia; and
  • Your combined savings, investments, and real estate are not worth more than $29,160, if you are married and living with your spouse, or $14,610 if you are not currently married or not living with your spouse.
    • (Do NOT count your home, vehicles, personal possessions, life insurance, burial plots, irrevocable burial contracts or back payments from Social Security or SSI.)
  • Your annual income must be limited to $19,140 for an individual or $25,860 for a married couple living together. Even if your annual income is higher, you may still be able to get some help.
    • Some examples where your income may be higher and you can still get Extra Help include if you or your spouse:
      • Support other family members who live with you.
      • Have earnings from work.
      • Live in Alaska or Hawaii.
  • EXCEPTION:  If you have Medicare and Supplemental Security Income (SSI) or Medicare and Medicaid [Medi-Cal] you automatically will get the extra help.   Publication 10525 * Social Security ONLINE Application for Extra Help  *  Publication 10508 Understand 

Here’s more assistance
Even if you have high assets & Income

Partnership for Rx Assistance

Call 1-800-Medicare (1-800-633-4227) and say “Medicaid” for the State Medicaid telephone number. Check our Medi-Cal page for California Be careful of Estate Recovery.

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.

Medicare Savings Program
Part B Premium Subsidies

Medi-Cal does not compensate or support agents to help you.  Our pro-bono work is pretty much limited to providing this website. If you learn anything of help to other website visitors, please put that information, including the link – web address in the comments section below.

Hints on Medicare.gov

Coupons – Assistance Programs from the Manufacturer
and Government Program

 

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.

Medicare.Gov
Manufacturer Finder Pharmaceutical Assistance

Get information on federal, state, and private assistance programs in your area by visiting benefitscheckup.org.

california rx card.com

So, these links are probably just for those on under 65 Health Care Plans.

Glaxo Smith Kline Rx Assistance

pfizer rx pathways.com

Merck

Humira

copaxone.com/shared-solutions for MS Multiple Sclerosis – Learn more on wikipedia

National MS Society.org Financial Assistance Programs

RxAssist.org (claims to be the Internet’s most comprehensive directory of patient assistance programs)

gleevec.com

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.

Medicare and You 2021 #10050   
Everything you want to know - Read Along

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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.

  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. 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?

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