What is LIS?
LIS stands for Low-Income Subsidy. It is a federal program that helps low-income Medicare members with their prescription drug coverage and related Part D expenses. This program is also known as Extra Help.
Who determines Eligibility?
Eligibility is determined by the Social Security Administration. Determination is based on an income and asset threshold, that can change annually.
Do I need to be enrolled in Both Medicare parts A & B to be eligible?
No, one can receive Extra Help even if they are only on Part A, or only on Part B. As long as they have either part a and/ or Part B, they are eligible to apply.
How do I know if I qualify?
People receiving additional government help like Medicaid, Medicare Savings Plans (QMB, SLMB), or Supplemental Security Income (SSI) will automatically be enrolled in LIS. These individuals will have no Part D premium or deductible. In addition, they will only pay between $1.35 to $3.95 for generic and $4 to 9.85 for brand-name drugs. These copay amounts are based on income levels
If I am not eligible for Medicaid, can I still be eligible for LIS?
Yes, this is possible as the income & resource threshold may be higher than the Medicaid threshold depending on your state.
What are the LIS/ Extra Help asset and income thresholds for non-Medicaid eligible individuals?
See the chart below.
Rates are for 48 States and DC**
*Do NOT count your home, vehicles, personal possessions, life insurance, burial plots, irrevocable burial contracts, or back payments from Social Security or SSI. IRA retirement savings count towards the resource limit
**Alaska and Hawaii have different income limits
As depicted in the chart above, the LIS program has different benefit levels. Some levels help pay for Part D premiums, as well as drug copays & coinsurances, while other levels provide less assistance. After you apply the Social Security Administration will determine your benefits based on income and resources.
How do I apply?
You can apply online through the social security administration https://secure.ssa.gov/i1020/Ee001View.action
or over the phone by contacting social security at 1-800-772-1213
Upon approval, you will have a special election period that will allow you to go over your Medicare Advantage or Prescription Drug plan and make any necessary changes. Those on LIS can make a change once per quarter for the first three quarters of the year.
LIS levels are reviewed by social security annually. These reviews are usually done in September. A form will be sent out to consumers and must be completed and returned to social security. If the form is not returned within 30 days, LIS will terminate at the end of the calendar year.
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Disclaimer: Views expressed by the writer are not a representation of CMS/ Medicare/Medicaid or any government entity. Never cancel current coverage until you are fully approved for the new rates.