Medicare beneficiaries who have limited income and assets may qualify for Extra Help with their prescription drug costs. This program is also known as "LIS," or Part D Low Income Subsidy. The Social Security Administration (SSA) and the Centers for Medicare and Medicaid Services (CMS) are the agencies that work together to provide this benefit.
Who qualifies for additional assistance?
Some people automatically get extra help. These include people who are enrolled in both Medicaid and Medicare (often called dual eligibles), those who receive Supplemental Security Income (SSI), and those who qualify for a Medicare Savings Program. These individuals do not need to apply for the program, although they may wish to consult a benefits counselor to determine the best Part D plan to fit their situation.
Anyone else who is not already enrolled in the above benefits must apply to Social Security for Extra Help.
Benefits of additional assistance
The amount of Extra Help a beneficiary receives depends on his or her income and resources. Beneficiaries will receive either a full subsidy or a partial subsidy. Be sure to review the Extra Help coverage and eligibility chart for more details. Most people who qualify for extra help will pay:
- No premiums
- No deductible (unless you receive the partial subsidy), and
- No more than $8.95 in 2020 for each drug covered by your plan.
In addition to lower out-of-pocket costs, beneficiaries with extra help have the following protections:
- A quarterly special enrollment period (once every three months between January and September + once during Annual Open Enrollment) to join or change Medicare Part D drug plans during the year. These opportunities allow people who get Extra Help not to wait until the Annual Open Enrollment Period (October 15 - December 7) to change plans. Any plan changes made outside of the Annual Open Enrollment Period will be valid for the following month. This is especially helpful for seniors/adults with disabilities who may need to start taking medications that are not on their current plan's formulary (approved drug list).
- No Part D late enrollment penalty, even if the beneficiary enrolls late (i.e., after first becoming eligible to join a Part D plan and had no other drug coverage).
Ways to apply for Additional Assistance
If you know an elderly person or adult living with a disability who may be eligible for Extra Help, direct them to the following:
- BenefitsCheckUp® has a direct link to submit applications for Extra Help to the Social Security Administration. In addition, the free online screening tool will tell applicants if they are likely to appear eligible for other benefits that can help with health care and prescription drug costs.
- Your local State Health Insurance Assistance Program (SHIP). SHIPs are federally funded to provide free, objective assistance to people with Medicare and their families. SHIPs can also help with applications for Extra Help and Medicare Savings Programs. To find your SHIP, call toll-free 877-839-2675 or visit the SHIP TA Center website.
- Individuals with Medicare can also apply directly through the Social Security Administration.
Information obtained from: National Council on Aging - https://www.ncoa.org/