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Medicare Extra Help Program

The Low Income Subsidy (LIS), also known as the Medicare Extra Help program, is available to beneficiaries who fall below certain income and personal resource limits. This is a federal program that helps pay for some or most of the costs associated with Medicare prescription drug coverage. This assistance may come in the form of lower copayments, drug plan premiums, or deductibles.

In 2013, if you qualify for the Extra Help program you will pay no more than a $2.65 copayment for generic drugs and no more than a $6.60 copayment for brand-name drugs covered under your plan's formulary. Based on income level, other eligible individuals may pay only a portion of their annual plan deductible or their monthly plan premiums. Additionally, individuals that are enrolled in the Extra Help program do not have a coverage gap, or “donut hole.”

Eligibility for Medicare Extra Help

To qualify for federal help with the costs of your prescription drug coverage, you must have assets and personal resources that fall below specific limits. These limits may change each year. For 2013, beneficiaries may qualify for Medicare Extra Help if they make less than $17,235 in annual income ($23,265 for a married couple) and less than $13,300 in personal resources ($26,580 for a married couple). Countable personal resources include stocks, bonds, and money in a checking or savings account. These resources do not include property, vehicles, burial plot and other burial expenses set aside up to $1,500, furniture, and other household items.

Certain beneficiaries automatically qualify and are enrolled in the Extra Help program. You may automatically qualify if you have Medicare and meet any of the following conditions:

  • You have full Medicaid coverage
  • You get help from your state Medicaid program with paying your Part B premiums
  • You receive Supplemental Security Income (SSI) benefits

Although you may automatically qualify one year, the income and resource limits change each year, so you may not in another year. If you do not automatically qualify in the upcoming year, you will receive a notice regarding this change. This does not mean that you do not qualify for Medicare Extra Help at all, but that you must apply to find out.

If you find that you do not qualify for federal assistance with your prescription drug costs, there may be other options available to you. You may contact your local Medicaid office or your State Health Insurance Assistance Program (SHIP) for more details. If you find that you qualify for no federal or state assistance, you may potentially lower your prescription drug costs using the following techniques:

  • See if you can trade a high-cost brand-name drug for an equally effective lower cost, generic drug
  • Ask your doctor about lower cost brand-name drugs
  • Consider taking advantage of mail-order pharmacies
  • Compare available Part D plans in your area to be sure that you are in the lowest cost option