Extra Help Programs
Low Income Subsidy (LIS)
Medicare "Extra Help," also known as the Low-Income Subsidy (LIS) program, is a program that helps low-income Medicare beneficiaries afford their Part D prescription drug costs. It can cover the costs of premiums, deductibles, and copayments, reducing the out-of-pocket expenses for covered prescription drugs.
What it does:
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Catastrophic Coverage:
Once your out-of-pocket drug costs reach the catastrophic coverage threshold($2,000 in 2025), you will have no more copayments.
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Automatic enrollment:
You may automatically qualify for Extra Help if you also receive Medicaid,Supplemental Security Income (SSI), or are enrolled in a Medicare Savings Program (MSP).
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Reduces or eliminates costs:
Extra Help helps beneficiaries pay for their Part D premiums, deductibles, and copayments, making it easier to afford their medications.
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Pays for most of the costs:
With Extra Help, you might pay no more than $4.90 for each generic drug and $12.15 for each brand-name drug in 2025.
Who is eligible:
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Income limits:
You generally qualify for Extra Help if your income and resources are below certain limits.
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Automatic eligibility:
If you have Medicaid, SSI, or are enrolled in an MSP, you automatically qualify.
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Application process:
If you don't automatically qualify, you can apply to the Social Security Administration (SSA) for Extra Help.
How to apply:
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If you don't automatically qualify:
You can apply for Extra Help by visiting the SSA website or by contacting them directly.
Key points to remember:
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Financial eligibility:
Your income and assets must be below certain limits to qualify for Extra Help.
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Automatic enrollment:
If you have Medicaid, SSI, or are enrolled in an MSP, you will automatically be enrolled in Extra Help.
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Annual application:
You may need to apply for Extra Help each year to ensure you continue to receive benefits.
Medicare Savings Program
Medicare Savings Programs (MSPs) are state-administered programs that help people with limited income and resources afford their Medicare costs.They are also known as Medicare Buy-In programs or Medicare Premium Payment Programs. MSPs can assist with paying for Medicare Parts A and B premiums, deductibles, coinsurance, and copayments.
Types of MSPs:
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QDWI (Qualified Disabled and Working Individual): Assists individuals who have disabilities and are working while meeting specific income and resource requirements.
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QMB (Qualified Medicare Beneficiary): Helps pay for Part A premiums, Part B premiums, deductibles, coinsurance, and copayments.
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SLMB (Specified Low-Income Medicare Beneficiary): Helps pay for Part B premiums.
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QI (Qualifying Individual): Helps pay for Part B premiums.
Benefits: Enrollment in an MSP can save you money on your Medicare costs, potentially freeing up funds for other essentials. Additionally, some MSPs provide "Extra Help" with Medicare Part D prescription drug costs.
Application: You can apply for an MSP with your state's Medicaid office.
Recertification: You will need to recertify your eligibility for an MSP every year.
How they work: MSPs are designed to help individuals with low incomes manage the financial burden of Medicare. They often cover a portion or all of the costs associated with Medicare Parts A and B, which include premiums, deductibles, coinsurance, and copayments.
Eligibility: To qualify for an MSP, you must meet certain income and resource requirements, which vary by state. You must also have or be eligible for Medicare Part A.