Medicare is an incredible healthcare resource for people over the age of 65. However, many Americans also find it difficult to pay for, specifically prescription costs that Medicare doesn’t cover. Many Medicare beneficiaries are unaware that they may qualify for Medicare’s Low Income Subsidy (LIS) or “Extra Help” program. If you have fixed or limited income, this program can help reduce or, in some instances, even eliminate many of those costs. Ultimately, this program could save you thousands annually on your premiums, deductibles, and copayments associated with Medicare prescription drug costs.

What Is Extra Help [Low Income Subsidy]?

Extra Help is a financial assistance program for people who are on Medicare but have limited income and resources available to pay for it. The program helps “subsidize” the out-of-pocket costs for prescription drugs.

What Does Medicare Extra Help Cover?

Individuals who qualify for the full Extra Help subsidy won’t have to pay any premiums or deductibles. They also will only pay $8.95 for each prescription drug that their plan covers. Individuals who only receive partial subsidies may still have premiums and deductibles but they will be substantially less than what they are under Original Medicare.

Is Medicare Part B Free with Extra Help?

Most people need to pay at least some premium for Medicare Part B. However, the exact number can be discounted heavily or even waived altogether for people with low income.

What Are the Different Levels of Extra Help?

There are four different levels of Extra Help available. They correspond to how much of your premium will be covered by the service. You can receive coverage that amounts to:

  • 100%
  • 75%
  • 50%
  • 25%

The exact amount that you qualify for will be based on your income and resources.

What Are Medicare Extra Help Income Limits in 2021?

The Extra Help income limit in 2021 is set at $19,140 for individuals who are living alone. That number rises to $25,860 for married couples who are living together.

Do I Need to Apply for Extra Help Every Year?

Once you qualify for Extra Help you don’t need to reapply every year. The government will automatically review and renew your status if you qualify. If you don’t qualify, then you will be sent documentation stating that and will only need to reapply at that point.

Does Social Security Count as Extra Help?

No, Social Security does not count as Extra Help at this time.

Can You Get Extra Help If You Already Have a Medicare Advantage Plan?

You cannot use Extra Help while still having a Medicare Advantage plan. You will need to choose one or the other.

Is Low Income Subsidy the Same as Medicaid?

Medicaid is a more expansive service than the Low Income Subsidy. It provides free or low-cost healthcare to any low-income person or family. The Low Income Subsidy is specifically for Medicare insurance holders who need help with their prescription drug costs.

What Is a Low Income Subsidy Rider?

Medicare’s Low Income Subsidy is meant to support people who need help paying for their prescription drug costs. Those who qualify will pay less each month on prescription drugs.

Medicare Savings Programs

Did you know your state may help you pay your Medicare premiums? It’s true. If you meet certain conditions, Medicare Savings Programs in your state may help pay Medicare Part A and Part B deductibles, coinsurance, and even copayments! There are four different Medicare Savings Programs:

Qualified Medicare Beneficiary

The Qualified Medicare Beneficiary (QMB) program helps pay for the costs of your Medicare Part A and Medicare Part B premiums, deductibles, coinsurance and copayments. It’s only available to individuals with the lowest incomes.

Specified Low-Income Medicare Beneficiary

Specified Low-Income Medicare Beneficiary is one step below the savings that are available from the QMB plan. It will help pay for Medicare Part B premiums only. If you live in Alaska or Hawaii, the income limits are slightly higher. 

Qualified Disabled and Working Individuals

This program only pays for Medicare Part A premiums. You can qualify for it if you meet one of the following criteria:

  • You’re disabled, under 65, and working
  • You returned to work and lost your premium-free coverage as a result
  • You aren’t getting state medical assistance
  • You meet the income and resource requirements for your state

Qualifying Individuals

If you don’t qualify for either QMB or Specified Low-Income Medicare Beneficiary, you may still qualify for this program. Qualifying Individuals covers the costs of Medicare Part B premiums for people who have Part A and limited income and resources. You also automatically qualify for the Extra Help program for prescription drugs. Qualifying Individuals applications are on a first-come, first-served basis. You must apply every year for Qualifying Individual benefits.

Contact Us For More Help

If you have additional questions about Medicare’s Low Income Subsidy (LIS) or Extra Help program, reach out to our partnered licensed agents today by filling out this form or giving us a call. They’re experts who can help you determine which Medicare subsidy option is best for your needs.