How to Qualify for Extra Help/Low-Income Subsidy (LIS) with Part D Costs

Eligibility for Extra Help/LIS for 2017

You are automatically enrolled in a drug plan with the Extra Help/Low-Income Subsidy (LIS) program for 2017 if you qualify for Medi-Cal or a certain type of Medicare Savings Program (Qualified Medicare Beneficiary, Specified Low-Income Medicare Beneficiary or Qualified Individual program). The chart below explains what you will pay for your Part D coverage depending on the Medi-Cal and/or Medicare Savings Program (MSP) program for which you qualify, assuming you are enrolled in a benchmark plan.

LIS Automatic Enrollment Income/Asset Levels & Costs

Your Income Is… (Note: does not include the $20 disregard) Your Assets Are at or Below…1 You Pay
Under 100% of the federal poverty level (FPL): 

Single: $7,390 

Couple: $11,090

  • No monthly premium
  • No annual deductible
  • Copayments of $1.20/generic and $3.70/brand name

Note: If you have Medi-Cal and are living in a nursing home or are receiving Medi-Cal Home and Community Based Services (HCBS), you will have no drug copayments.

More than 100% but less than 135% of the FPL: 

Single: $7,390 

Couple: $11,090

  • No monthly premium
  • No annual deductible
  • Copayments of $3.30/generic and $8.25/brand name
More than 135% of the FPL and you met your Medi-Cal share of cost (SOC) any single month since July 1, 2016: 

  • Single: >$1,357/mo., $16,281/yr.
  • Couple: >$1,827/mo., $21,924/yr.
Single:
$2,000Couple: $3,000
  • No monthly premium
  • No annual deductible
  • Copayments of $3.30/generic and $8.25/brand name

1 Asset limit does not include the allowed amount for burial expenses: Single, $1,500; Couple, $3,000.

If you do not meet the qualifications in the chart above, you can apply1 for the Extra Help/LIS through the Social Security Administration if you meet the qualifications in the chart below. You will not automatically be enrolled in the LIS program.

LIS SelfEnrollment Income/Asset Levels & Costs

Your Income Is Below… (Note: does not include the $20 disregard) Your Assets Are at or Below2 You Pay
135% of the FPL: 

  • Single: $1,357/mo., $16,281/yr.
  • Couple: $1,827/mo., $21,924/yr.
Single:
$8,890 Couple: $14,090
  • No monthly premium
  • No annual deductible
  • Copayments of $3.30/generic and $8.25/brand name
135% of the FPL: 

  • Single: $1,357/mo., $16,281/yr.
  • Couple: $1,827/mo., $21,924/yr.
Single: $13,820 

Couple: $27,600

  • No monthly premium
  • $82 annual deductible
  • 15% coinsurance; copayments up to $3.30/generic and $8.25/brand-name during catastrophic coverage
150% of the FPL: 

  • Single: $1,508/mo., $18,090/yr.
  • Couple: $2,030/mo., $24,360/yr.
Single: $13,820 

Couple: $27,600

  • Sliding-scale monthly premiums
  • $82 annual deductible
  • 15% coinsurance; copayments up to $3.30/generic and $8.25/brand-name during catastrophic coverage

1You must also enroll in a Medicare Part D drug plan if you qualify for Extra Help/LIS.
2 Asset limit includes the allowed amount for burial expenses: Single, $1,500; Couple, $3,000.