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Seniors With Limited Income and Resources May Qualify for the LIS for Prescription Drug Coverage

Prescription drug coverage is an important (and more or less obligatory) part of Medicare coverage. We are currently in Annual Enrollment Period (AEP) between October 15 and December 7, which is the time of year where kupuna can change their Medicare Advantage Plan or their prescription drug plan. If you are thinking about changing prescription drug plans, this is the time to schedule an appointment with your Medicare agent to go over your options. The agent can also help you apply for the Low-Income Subsidy (LIS) – also called Extra Help - to get help paying for prescription drugs and lower the costs of Medicare prescription drug coverage.

Seniors With Limited Income and Resources May Qualify for the LIS for Prescription Drug Coverage


Who automatically qualifies for Part D Extra Help?


Some kupuna automatically qualify for Extra Help:

  • Seniors who are dual eligible (enrolled in both Medicaid and Medicare)

  • Seniors receiving Supplemental Security Income (SSI)

  • Seniors who qualify for a Medicare Savings Program

What should I do if I don’t qualify automatically for the Low-Income Subsidy (Extra Help)?


If you don’t automatically qualify for the LIS, but your yearly income and resources are under the Extra Help Limit or they are close to the limit, you should apply anyway. Seniors with annual income higher than the limits may still qualify if they or their spouse:

  • Support other family members who live with you

  • Has earnings from work

  • Lives in Alaska or Hawaii

The 2021 limits are as follows:

  • Yearly income of $19,140 or less for an individual or $25,860 or less for a married couple who lives together.

  • Resources of $14,610 or less for an individual or $29,160 or less for a married couple who lives together. While resources include savings and stocks, they do not include your home, car or the value of any life insurance policies.

The Extra Help limits may change from year to year so it is worth asking your Medicare agent if you qualify.


Low-Income Subsidy Notifications to watch out for


Eligibility for LIS may change from year to year so it’s important to watch out for targeted notifications from CMS that explain changes to your Extra Help eligibility.


1. Loss of coverage


In September, CMS mails a notice (CMS Publication No. 11198) (PDF) on gray paper to seniors who will no longer automatically get the LIS. The letter also encourages these seniors to fill out and send in a new LIS application with a postage paid envelope


2. Change to co-payment


In early October, CMS mails a notice (CMS Publication No. 11199) (PDF) on orange paper to seniors who still qualify for Extra Help, but have a change to their co-payment coming.


3. Reassigned to a new plan


In early November, CMS mails a notice on blue paper (CMS Publication No. 11208) (PDF) to seniors who qualify for the LIS, but will be reassigned to a new prescription drug plan starting on January 1 the following year. Reasons for reassignment are:

  • Qualifying for the full (100%) premium subsidy

  • Were enrolled in their current plan by CMS

  • Currently enrolled in a prescription drug plan that is raising the premium above the low-income premium amount

  • Currently enrolled in a prescription drug plan that is leaving the Medicare program

4. Changes for people who chose their own plan


In early November, CMS mails a notice (CMS Publication No. 11267) (PDF) to seniors:

  • Whose premium cost is going to increase but they will not be reassigned because they chose their own plan

  • Who qualify for the full (100%) premium subsidy, but are in a drug plan that will be increasing their premium amount to an amount that’s more than the standard low-income premium subsidy amount


Our independent insurance agents are dedicated to assisting people on Medicare and those who are ready to transition from employer coverage to personal retirement coverage. We help kupuna understand their benefits options and apply for additional coverage, as needed. Because we represent all the major Medicare Advantage and supplement plans in Hawaii, we are able to offer unbiased advice; all at no cost to our clients.


At PBC, our clients are our number one priority and we look forward to getting to know you and your needs. Call us today at (808) 738-4500 to see how we may be of assistance.

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