Extra Help with Medicare Prescription Drug Costs

The Federal government has a program called Extra Help (also called the Low Income Subsidy-LIS-Program). This program helps those with limited income and resources pay for their prescription drug costs associated with Medicare Part D.

In order to use the Extra Help Program you must be enrolled in a Medicare Prescription Drug Plan (PDP) or Medicare Advantage Prescription Drug (MA-PD) plan. If you qualify for Extra Help, you will generally pay less in drug premiums and copayments. You also will be covered during the Coverage Gap and will not have to pay a Late Enrollment Penalty. Many people are eligible for these savings and aren't taking advantage of this. To see if you qualify for Extra Help, call:

  • Medicare at 1-800-MEDICARE (1-800-633-4227) 24 hours a day/7 days a week. TTY users call 1-877-486-2048; or

  • Social Security at 1-800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday. TTY users call 1-800-325-0778; or

  • your State Medicaid Office; or

  • visit www.ssa.gov (by clicking on this link you will be leaving our website).

What are the benefits of receiving Extra Help?

There are four different levels of Extra Help that you may qualify for, based on your eligibility. The four levels of Extra Help cover 100%, 75%, 50% or 25% of your monthly Medicare Part D plan premium. Also, at the pharmacy, you will be charged lower copayments for your prescription drugs.

Note: Extra Help will not pay for your monthly Medicare Part B premium. You must continue to pay your Medicare Part B premium.

Eligibility for Medicare Extra Help

In 2015, you may qualify if you have up to $17,655 in yearly income ($23,895 for a married couple) and up to $13,640 in resources ($27,250 for a married couple). Most people with Medicare have to apply directly with the Social Security Administration for Extra Help.

Some groups are automatically eligible. You automatically qualify for Extra Help if you have Medicare and:

  • full Medicaid coverage (full dual eligibles); or

  • a Medicare Savings Program (partial dual eligibles); or

  • receive needs based Supplemental Security Income (SSI) benefits (by clicking on this link you will be leaving our website)

To find out more about eligibility in Extra Help, please visit the Medicare website at http://www.medicare.gov/your-medicare-costs/help-paying-costs/extra-help/level-of-extra-help.html (by clicking on this link you will be leaving our website).

Using the Best Available Evidence Policy (BAE)

You can use the Best Available Evidence (BAE) policy when the information that your Medicare Prescription Drug Plan (PDP) or Medicare Advantage Prescription Drug (MA-PD) plan has on your Low Income Subsidy is not up-to-date. Because of data exchanges, the right information is not always with your pharmacist or your PDP or MA-PD plan when you need it.

When this happens you can use the BAE to show that you qualify. Such evidence may be your award letter from the Social Security Administration, your Medicaid card or other proof that you were found eligible for Extra Help. When you give this information to your PDP or MA-PD plan, your plan will update your Low Income Subsidy information as soon as possible.

For more information on Low Income Subsidy and BAE, please visit the following websites (By clicking on the links below you will be leaving our website):

Enrollment disclaimer information:
This information is not a complete description of benefits. For more information contact the Plan. Limitations, copayments, and restrictions may apply. Limitations, copayments, and restrictions may apply. Benefits, premiums and/or copayments/co-insurance may change on January 1 of each year. The Formulary, pharmacy network, and/or provider network may change at any time. You will receive notice when necessary.

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