Eligibility for Extra Help

Eligibility for Extra Help


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Eligibility for Extra Help

Medicare beneficiaries with limited incomes may qualify for the Medicare Part D "Extra Help" program. This is also known as the Low Income Subsidy (LIS) program.

The program was designed to help people with limited incomes pay for prescription drugs. If you qualify for Medicare Part D Etra Help, you will pay less in drug premiums and copayments or coinsurance. You also will be covered during the Coverage Gap (the "Donut Hole"), and you will not have to pay late enrollment penalties. For more information on the LIS Extra Help Program, click here.

Click Here for a 2018 summary of monthly plan premiums for those eligible for extra help.

Click Here for a 2019 summary of monthly plan premiums for those eligible for extra help.

Some people with limited resources and income may be able to get Extra Help to pay all or some of the costs of a Medicare Part D plan, including premiums, annual deductibles, and copays. According to Social Security Administration (SSA), Extra Help is estimated to be worth about $4000 per year. Visit the Social Security website for the latest information on eligibility for Extra Help. 

There are two ways to get Extra Help:

  1. Some people need to apply directly through the SSA
  2. Others automatically receive Extra Help without applying through their State Medicaid Program

You are automatically eligible for Extra Help if:

  • You are eligible to receive both Medicare and Medicaid (dual eligibility)
  • You have a Medicare Savings program (partial dual eligibility)
  • You receive Supplemental Security Income (SSI) benefits but not Medicaid

Note: If any of these apply to you, you may also get help to pay your monthly Medicare Part B premium.

Applying for Extra Help with Medicare

In most cases, you apply for Extra Help either through the Social Security Administration or through your state Medicaid Office. For more information or to apply:

  • Visit your local Social Security Office
  • Call toll-free, 1-800-772-1213, between 7 a.m. and 7 p.m. Monday through Friday. TTY users should call 1-800-325-0778 
  • Visit Social Security Administration's website

Completing the Extra Help Application Form:

To ensure accuracy, the Social Security Administration encourages you to complete the Extra Help form with the help of a family member or a caregiver. The application requires you to identify the assets you own alone, with your spouse or with someone else, not including your home, any vehicles, burial plots or personal possessions. Note: It will save time and make the application process easier if you review all of your income and gather your records before starting the application for Extra Help with Medicare Prescription Drug Plan Costs.

Records you will need to complete the Extra Help Application Form include:

  • Current account balance statements from banks, credit unions or other financial institutions
  • Investment statements and stock certificates
  • Life insurance policy statements and tax returns
  • Pension award letters and payroll slips

Extra Help Application Forms are available by calling the Social Security Administration and by visiting the Social Security Administration's website.

Extra Help Program 2018 Income and Asset Limits

To qualify for extra help with Medicare prescription drug plan costs in 2018, your annual income must be limited to $18,090 for an individual ($24,360 for a married couple living together). Note: Income and asset amounts may change each year.

Even if your annual income is higher, you still may be able to get some help. Some examples where your income may be higher are if you or your spouse:

  • Support other family members who live with you;
  • Have earnings from work; or
  • Live in Alaska or Hawaii.

Using the Best Available Evidence Policy (BAE)

Your Low Income Subsidy (LIS) information may not be up to date. You can use the Best Available Evidence (BAE) policy when the LIS information shown by your drug plan needs to be updated. 

If your information is incorrect, you can use the BAE policy to show that you qualify, using such evidence as your award letter from Social Security Administration, your Medicaid card or other proof of your eligibility for Extra Help. When you provide this information to your Medicare Prescription Drug Plan, your plan will update your Low Income Subsidy information as soon as possible.

Helpful Links on Medicare Part D Extra Help  Eligibility

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