Understanding Extra Help: Medicare’s Low-Income Subsidy (LIS) Program
What is Extra Help and How Can It Benefit You?
Medicare Extra Help eligibility also known as the Low-Income Subsidy (LIS) program, assists people with limited financial resources in paying for their Medicare Part D prescription drug coverage. This program can significantly reduce your healthcare costs.
Benefits of Extra Help
When you receive Extra Help, you may enjoy:
- Lower or $0 monthly premiums
- $0 initial deductible
- Continuous coverage through the Donut Hole or Coverage Gap
- Minimal costs for prescription drugs covered by your Medicare Part D plan
Are You Eligible for Extra Help?
Income and Resource Limits for 2024-2025
Your eligibility for Extra Help depends on your income and financial resources. For 2024 and early 2025, you qualify if:
- Your annual income is below $22,590 for a single person or $30,660 for a married couple living together
- Your assets are below $17,220 for a single person or $34,360 if married (including a $1,500 burial allowance)
What Counts as Income and Resources?
Medicare Extra Help eligibility
The program excludes certain items from income calculations:
- Housing assistance
- Medical treatment and drugs
- Food stamp assistance
Resources (assets) include:
- Bank accounts
- Stocks and bonds
- Real estate (other than your primary residence)
However, the following are not considered resources:
- Your primary residence
- Your car
- Personal possessions like furniture and jewelry
Extra Help and Medicaid: What You Need to Know
Automatic Qualification through Medicaid
If you qualify for your state’s Medicaid program, you automatically qualify for Extra Help. Medicare will send you a letter confirming your Extra Help status. Keep this letter for your records.
Enrolling in a Medicare Part D Plan
To receive prescription drug coverage, you must join a Medicare Part D drug plan (PDP) or Medicare Advantage plan (MAPD), even if you qualify for Extra Help.
Automatic Enrollment Process
If you don’t choose a plan, Medicare may automatically enroll you to ensure you have drug coverage. They will notify you by letter about your coverage start date.
Choosing Your Plan or Opting Out
If you prefer to select your plan or want to keep your employer or union coverage:
- Call 1-800-MEDICARE (1-800-633-4227)
- Contact the plan listed in your letter
- Inform a Medicare representative about your decision
Remember: You must be enrolled in a Medicare Part D drug plan to benefit from Extra Help.
Changes to Extra Help: Goodbye to Partial Coverage
Full Extra Help Benefits Expansion
Starting in 2024, the Inflation Reduction Act (IRA) has expanded full Extra Help benefits to people at or below 150% of the Federal Poverty Level (FPL). As a result, the partial Extra Help category (135% to 150% of FPL) no longer exists.
By understanding Extra Help, you can make informed decisions about your Medicare coverage and potentially save on prescription drug costs.
Medicare Part D Extra Help (LIS)
