Medicare Extra Help (LIS): Understanding the Low-Income Subsidy

Medicare Extra Help (LIS): Save on Prescription Drug Costs

If you have Medicare and need help paying for your prescription medications, the Medicare Extra Help program may significantly reduce your out-of-pocket costs. Extra Help is designed to assist eligible individuals with Medicare Part D premiums, deductibles, and prescription drug copayments.

For many people, the savings from Extra Help can total hundreds or thousands of dollars each year, making it one of the most valuable forms of financial assistance available to Medicare beneficiaries.

What Is Medicare Extra Help (LIS)?

Medicare Extra Help (LIS) is a cost-saving program administered by the Social Security Administration (SSA) in partnership with the Centers for Medicare & Medicaid Services (CMS). It is intended for individuals who have limited income and resources and need assistance paying for Medicare Part D prescription drug coverage.

If you qualify for Extra Help, you may receive benefits such as:

• Reduced or $0 monthly Part D premiums (depending on the plan and state)
• Lower or eliminated annual deductibles
• Reduced copayments or coinsurance for your covered medications
• Protection from the Part D coverage gap (“donut hole”)
• Year-round Special Enrollment Period for changing Medicare Part D plans

Who Qualifies for Medicare Extra Help?

Eligibility for Medicare Extra Help is based on your income and financial resources. Each year, there are specific income and asset limits set at the federal level. These limits consider factors such as:

• Total household income
• Resources like savings, investments, and money in bank accounts
• Living situation, including whether you are single, married, or living with dependents

Some people may qualify automatically if they already receive certain types of assistance, such as:

• Medicaid
• Supplemental Security Income (SSI)
• Help from a Medicare Savings Program

Even if you do not qualify automatically, you can still apply and may be eligible for full or partial Extra Help based on your current income and resources.

How to Apply for Medicare Extra Help (LIS)

Applying for Medicare Extra Help is free, and you can complete the application online, by phone, by mail, or in person. The application is handled through the Social Security Administration (SSA).

Ways you can apply:

• Apply online at SSA.gov/extrahelp
• Call Social Security at 1-800-772-1213 (TTY 1-800-325-0778)
• Visit your local Social Security office
• Request a paper application by mail

Once your application is processed, you will receive a notice explaining whether you qualify, the level of Extra Help you may receive, and what to do next when choosing or updating your Medicare Part D coverage.

Key Things to Remember About Extra Help

• Extra Help can significantly reduce your Medicare Part D prescription drug costs.
• Eligibility is based on income and resources and may change from year to year.
• You can apply at any time if your financial situation changes.
• You may have a Special Enrollment Period to change Medicare Part D plans after you qualify.

Staying informed about your options and reviewing your coverage regularly can help you make the most of your Medicare benefits.