Some people are automatically enrolled in the Part D Extra Help/LIS program while others must apply themselves. On this page, you’ll find information on how to apply for Extra Help with Part D costs, depending on your situation.
Topics on this page:
- If You Have Both Medicare & Medi-Cal
- If You Have Medi-Cal with a Share of Cost (SOC)
- If You Are Enrolled in a Medicare Savings Program (MSP)
- If You Have Low Income & Don’t Qualify for Medi-Cal or an MSP
- If You Have Drug Coverage Through a Retiree Plan
- If You Are Enrolled in a Medicare Advantage Plan
1. If You Have Both Medicare & Medi-Cal
If you have both Medicare and Medi-Cal (Medicaid in California), you do not need to apply for the Low-Income Subsidy (LIS) program because you will automatically be enrolled (see our chart regarding who is automatically enrolled, income and asset levels, and costs of the LIS program). Medicare will send you a letter informing you of the automatic enrollment in LIS, and a separate letter explaining how you will be automatically enrolled in a Part D plan for your prescription drug coverage, if you have not already chosen one by the time you become eligible for Part D.
We recommend you enroll in a plan before your Medicare coverage begins so you can choose the plan you prefer and prevent any gap in coverage. Your Part D benefits will begin the month of your Medicare eligibility. In addition, because drug plans cover different drugs, enrolling yourself in a plan (versus waiting for Medicare to automatically assign you to a plan) allows you to choose a plan that will cover all or most of the drugs you are taking.
2. If You Have Medi-Cal with a Share of Cost (SOC)
If you have Medi-Cal with a share of cost (SOC), you may qualify for the LIS program. Unlike those who have full-benefit Medi-Cal, you do not automatically qualify for LIS, unless you meet your SOC in a given month. If you do not meet your SOC, you can apply for LIS at your local Social Security Administration office. You may qualify if your income and assets meet the requirements.
If you meet your SOC for any one month between January and June, you qualify for the LIS program for the rest of the calendar year. If you meet your SOC for any one month between July and December, you qualify for the LIS for the rest of the calendar year as well as the following year. Learn more about Medi-Cal with SOC.
3. If You Are Enrolled in a Medicare Savings Program (MSP)
If you have Medicare and don’t qualify for Medi-Cal, but are enrolled in one of 3 Medicare Savings Programs (MSPs), you can also get LIS program benefits automatically. These MSPs are:
- Qualified Medicare Beneficiary (QMB)
- Specified Low-Income Medicare Beneficiary (SLMB)
- Qualified Individual (QI)
Like people who have both Medicare and full-benefit Medi-Cal, you will be automatically enrolled in a Part D plan if you do not choose one yourself. This may occur a few months after you become eligible for the Part D benefit.
We recommend you enroll in a plan before your Medicare coverage begins. This way you can 1) prevent any gaps in drug coverage, and 2) choose a plan that best fits your needs and covers most, if not all of your drugs.
Learn more about Medicare Savings Programs and see our chart regarding who is automatically enrolled, income and asset levels, and costs of the LIS program.
4. If You Have Low Income & Don’t Qualify for Medi-Cal or an MSP
If you have Medicare with an income below 150% of the federal poverty level (FPL) and meet the asset requirement, but are not on other assistance (Medi-Cal, Medi-Cal with SOC or an MSP), you can apply for the LIS program at your local Social Security or Medi-Cal office. If you apply at the Medi-Cal office, asked to be screened for qualification for other programs. You may also apply for LIS by phone (1-800-772-1213) or on the Social Security website.
The LIS program has several different levels of subsidy. If your income is higher, between 135-150% of the FPL, you may receive a partial subsidy. If you qualify for the partial subsidy, you may need to pay a percentage of the premium (depending on your income) and a deductible, even if you enroll in a benchmark prescription drug plan. See the last 2 rows on the LIS chart.
If you apply for the LIS program and are found eligible, you will be assigned to a Part D plan if you have not already chosen one yourself (similar to those enrolled in an MSP). This will usually occur a few months after you become eligible for the LIS program.
5. If You Have Drug Coverage Through a Retiree Plan
Beneficiaries with low income who have prescription drug coverage as a retiree benefit should check with the company that processes their retiree benefits before signing up for the LIS program or a Medicare Part D plan. Some low-income retirees are permitted to keep their retiree coverage and receive the Part D extra help, while others are not.
6. If You Are Enrolled in a Medicare Advantage Plan
You can also receive the LIS benefit if you enroll in a Medicare Advantage plan with prescription drug coverage (MA-PD). LIS reduces some or all of the premium that goes toward the prescription drug benefit. However, you may be fully responsible for the premium that goes toward medical and hospital benefits. Learn more about Medicare Advantage.
See How to Qualify for an easy-to-read chart on income and asset levels for the LIS program, what costs are covered and what you will pay if you qualify for the full or partial LIS subsidy.