For those with limited resources who face high prescription and insurance costs, there’s a fantastic Medicare program for your needs. Extra Help, known as Low Income Subsidy or “LIS,” provides financial assistance with Medicare Part D plans. Covered expenses generally include copays, premiums, and deductibles related to Medicare’s prescription drug coverage. Extra Help will also waive the Medicare Part D penalty for anyone affected by it. Let’s dive into this plan together and see how you may benefit from this assistance.
People limited resources may struggle to afford Part D coverage for their prescriptions. This led to the creation of Extra Help to fill the gap. The plan reduces out-of-pocket costs for copays, premiums, and deductibles through various subsidies.
Extra Help plans place prescription drugs into tiers to reduce overall costs. While each tier varies from plan to plan, higher tiers generally feature more expensive copays. However, a copayment is sometimes reduced upon your doctor’s request if the prescription is needed.
One example involves the monthly cost of insulin. Through recent regulatory action, a price cap of $35 per month on insulin is now in place for all Part D plans. While price ceilings are new to Extra Help, this action alone shows the value offered by this Low Income Subsidy.
Additionally, anybody receiving a Low Income Subsidy can utilize Medicare’s Special Enrollment Period from January to September. In this period, changes can be made to Plan D coverage once per quarter with Extra Help.
Anybody looking to apply for Extra Help must have Part A or B coverage and meet certain financial or enrollment requirements.
To qualify financially, an individual must earn $20,385 or less in annual income and own $15,510 or less in "counted assets." Married applicants must meet similar thresholds of $27,465 or less in yearly income and hold $30,950 or less in relevant assets.
Assets that factor into your qualification include cash, retirement, stocks, bonds, mutual funds, two or more cars, and secondary real estate. Certain assets that don’t affect your qualification include a primary home, one automobile, burial plots, or $1,500 in savings for burial expenses.
Another way to qualify is through enrollment in specific programs. Those with full Medicaid coverage, state assistance in Part B premiums, and Supplemental Security Income (SSI) are enrolled automatically in Extra Help. This automatic enrollment will be maintained unless it’s updated before the end of the year.
New members receive an introductory letter describing the added cost and coverage as part of the year’s membership. If you qualify for the program but haven’t received a letter by October 1st, then you can apply online or at your local SSA office. We’d also be happy to assist you with this process.
Keep in mind that Extra Help requires an annual evaluation of your eligibility. If you have Medicaid, Supplemental Security Income, or a Medicare Savings Program, then you will qualify for LIS. Once the Social Security Administration is notified of your eligibility, then you’ll be enrolled in Extra Help.
For those who originally applied for LIS, you may need to reapply before the end of the year. The Social Security Administration will send an application in August or September if they believe you may no longer qualify. After receiving the application, you have 30 days to reapply with your updated information. If you need a longer application period, then please call your local Social Security office to request an extension.
If you qualify for this helpful program but aren’t enrolled yet, then we encourage you to apply right away. Simply visit the SSA’s secure website and click the “Apply Now” button at the bottom of the page. We encourage you to reach out if you have questions about how to apply for Extra Help.
If you need any additional guidance or assistance, we’re always here to help you! Please give us a call or even send a message to arrange your free consultation today. We’ll gladly walk you through the application process at your convenience.
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