Understanding Medicare's Extra Help Program to reduce Prescription Drug Costs.
Updated: Sep 14
Extra Help (also known as the Low-Income Subsidy, or LIS, program) is designed to provide assistance to qualified Medicare beneficiaries with limited income and resources to help them afford their prescription drug costs. It is overseen by the federal government via the Centers for Medicare & Medicaid Services (CMS) and administered locally by the Social Security Administration (SSA). Medicare beneficiaries with incomes under 135% of the Federal Poverty Level (or FPL) are considered fully eligible for Extra Help, and those under 150% are partially eligible. However, as part of the Inflation Reduction Act, starting in 2024 all beneficiaries under 150% of the FPL will be considered fully eligible, and partial eligibility will be eliminated.
To qualify for full Extra Help in 2023, your annual income must be under $21,870 for an individual or $29,580 for a married couple living together, and your resources must be limited to $16,660 for an individual or $33,240 for a married couple living together. If you are approved for Extra Help, here are some of the benefits you could receive:
Reduced or Eliminated Part D Premiums: Your Medicare Part D prescription drug plan premiums can be either significantly reduced or completely covered by the subsidy.
Lower cost-sharing: You will have lower deductibles, copayments, and coinsurance for your medications.
No Coverage Gap (Donut Hole): The Medicare Part D coverage gap, also known as the "donut hole," is a temporary limit on what the drug plan will cover for prescription drugs. If you qualify for full Extra Help, there is no coverage gap, meaning you will continue to receive cost assistance even in the coverage gap phase.
Catastrophic Coverage: Once your out-of-pocket spending on prescription drugs reaches a certain threshold (catastrophic coverage threshold), you qualify for catastrophic coverage. For those with Extra Help, cost-sharing in the catastrophic coverage phase is reduced or eliminated.
What's more, qualifying for Extra Help can help you avoid the Part D late enrollment penalty, if you are subject to it. The Part D penalty is a lifetime premium increase imposed by Medicare if you go without creditable prescription drug coverage for a continuous period of 63 days or more after your Medicare Initial Enrollment Period (IEP) has ended. If you qualify for Extra Help and do not have Part D coverage, you will be granted a Special Enrollment Period (SEP) during which you can enroll in a Part D plan without incurring the penalty. If you have already been paying the Part D penalty at the time you qualify, it will be waived moving forward as long as you qualify for Extra Help and you maintain drug coverage.
If you are on Minnesota's Medical Assistance (MA) or have qualified for Part B premium reductions through a Medicare Savings Plan (MSP), your enrollment in Extra Help should be automatic. If not, you'll have to apply. To find out if you qualify for Extra Help (Low-Income Subsidy) under Medicare and to apply, you can:
Call the Social Security Administration: 1-800-772-1213 (TTY 1-800-325-0778) to get assistance with the application process.
Visit a Local Social Security Office: To find the nearest office, use the SSA's office locator tool on their website.
Contact a licensed insurance agent who specializes in Medicare who can help you access the valuable benefits provided by the Extra Help program. These services are available at no cost to you.
When checking for eligibility, you will need to provide information about your income, resources, and current Medicare enrollment status.
Overall, Extra Help plays a vital role in making healthcare more affordable and accessible for low-income Medicare beneficiaries. It contributes to better health outcomes, financial stability, and an improved quality of life for those who may otherwise struggle to afford necessary prescription drugs. If you believe you may be a candidate for Extra Help, reach out for assistance today. Qualifying for the program could save you thousands of dollars annually while also helping you achieve peace of mind, helping you access the medications you need without facing financial barriers.