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What Seniors Need to Know About the Low Income Subsidy Program for Prescription Drugs: Extra Help

Updated: May 18, 2021

Every senior should have access to life saving prescription medications. Since 2006, Medicare enrollees have been able to purchase Medicare Part D, prescription drug coverage. Unfortunately, this coverage comes at a cost that not everyone can afford. In order to expand access to prescription drugs for low income and low-resource seniors, the Centers for Medicaid & Medicare Services offers a low-income subsidy for prescription medications through a program called Extra Help or the Part D Low-Income Subsidy (LIS).

This federal program helps beneficiaries pay for a small to large percentage of their out-of-pocket costs for Medicare prescription drug coverage. Out of pocket costs include premiums, deductibles, and coinsurance. There are different levels of help offered by the program, depending on a person’s income and assets. If you are unsure if you are paying the right amount, it’s a good idea to call your drug plan. When you call, you may be asked to provide information so they can confirm which level of Extra Help you qualify for.

For assistance applying for Extra Help, contact Premier Benefit Consultants.

Benefits of the Extra Help program

In addition to paying part of the Part D premium and lowering the cost of prescription drugs, kupuna who qualify for the Extra Help program are entitled to a Special Enrollment Period (SEP) during the first nine months of the year to enroll in a Part D plan or to switch between plans. The program also erases any Part D late enrollment penalty a person was assessed for delayed Part D enrollment.

What kupuna need to know about the low-income subsidy program for prescription medications called Extra Help

Here are four important things to know about the Extra Help program:

Extra Help does not replace Medicare Part D; it is not a standalone plan. In order to access the Extra Help program, you will need to have a Part D plan.

In order to use the benefits of the Extra Help program, prescriptions should be listed on your plans formulary and should be filled at a pharmacy in your plan’s network.

Note that Medicaid beneficiaries with some types of union, employer or retiree drug coverage may be allowed to opt out of Extra Help. Your local Medicaid office can show you how to turn down Part D without losing your Medicaid coverage.

If you are eligible for Extra Help but already have other creditable drug coverage, it’s a good idea to assess your costs and coverage before making the decision to enroll in Medicare Part D and Extra Help or whether to keep your current drug coverage. A Medicare insurance agent may be able to help with your analysis.

Extra Help eligibility

Extra help eligibility is primarily based on your monthly income and your assets. Note that these amounts may change from year to year so it is important to get updated information. The numbers can be found at the Extra Help income and asset limit chart. Note that these limits include a $20 income disregard that the Social Security Administration (SSA) automatically subtracts from your monthly unearned income such as retirement benefits.

There are seniors who still qualify for Extra Help because the type of income and/or assets they have may not be counted, on top of the $20 income disregard. For example, seniors who are registered for Medicaid, Supplemental Security Income (SSI), or a Medicare Savings Program (MSP), are automatically qualified for Extra Help even if they don’t meet the monthly income and asset maximum.

Click here to learn more about Extra Help eligibility.

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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