Low Income Subsidy/Extra Help for Prescription Drug Costs

Low Income Subsidy (LIS/Extra Help) program helps pay for a portion of Part D prescription drug plan costs, including Part D premiums, deductibles, and copayments. Depending on your income and assets, you may qualify for a full or partial subsidy. The Social Security Administration (SSA) and Centers for Medicare & Medicaid Services (CMS) work together to administer LIS/Extra Help.

Online applications are available http://www.ssa.gov/medicare/part-d-extra-help. There is a prescreen to see if you should proceed. Paper applications can be requested from the SSA to be sent by mail or a copy can be obtained at your local SSA office. A decision letter will be mailed to the applicant upon determination of eligibility, usually within three weeks of a completed application. Once found eligible, participants receive LIS for at least the remainder of the year.

If you qualify these benefits are also available:

• Access to prescription drug coverage

• Waiver for Part D late enrollment penalty

• Eligibility for several Special Enrollment Periods (SEP) as participants can change plans once during each of the first three quarters and again during the Annual Enrollment Period (Oct. 15 - Dec. 7)

• Potential auto-enrollment in Medicare Savings Programs (such as QMB, SLMB, and QI)

You must satisfy three requirements or one special condition for eligibility:

• Have Medicare Part A and/or Part B

• Live within the U.S. (50 states or Washington D.C.)

• Meet additional eligibility criteria

• Receive some form of Medicaid (community or institutional), Supplemental Security Income (SSI), or be enrolled in a Medicare Savings Program (such as QMB, SLMB, and QI)

Those receiving either Medicaid, SSI, or enrolled in a Medicare Savings Program do not need to apply for LIS as you should be automatically enrolled in LIS.

What does Full Help cover?

Full Help covers those with lower incomes/fewer resources. Both the deductible and the plan premium for Part D are waived; for the premium to be waived, enrollment in a “benchmark” plan is required (meaning the plan is below the LIS premium amount). The benchmark in 2023 for Montana is $39.87.

People with full Extra Help will pay copays of between $1.45-$4.30 for generic drugs, and between $4.15-$10.35 for brand name drugs. After their total out-of-pocket drug expenses reach the catastrophic threshold ($7,400 in 2023), the beneficiary has no copays.

What does

Partial Help cover?

Partial Help covers those with slightly higher incomes/resources. The premium is either waived or an income-based sliding scale is used to determine benefits. The prescription drug plan has a $104 deductible, a 15 percent coinsurance (for covered drugs) and copays of $4.15 for generic medications and $10.35 for brand-name medications.

If you would like more information, would like to see if you qualify or need assistance with your application call your local SHIP counselor.

To find your local SHIP counselor call: 1-800-551-3191.