Eligibility for Extra Help/LIS for 2023
You will be automatically enrolled in a drug plan with the Extra Help/Low-Income Subsidy (LIS) program for 2023 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.
You have… | Your Assets Are at or Below…1 | You Pay |
---|---|---|
Medi-Cal without a Share of Cost (SOC). This includes the Aged & Disabled Federal Poverty Level program (A&D FPL). Medi-Cal with a SOC and your SOC is met in any one month. | Single: $130,000 Couple: $195,000 |
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. |
a Medicare Savings Program, such as Qualified Medicare Beneficiary (QMB), Specified Low-Income Beneficiary (SLMB) or Qualified Individual (QI) program. | Single: $130,000 Couple: $195,000 |
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1 Asset limit does not include the allowed amount for burial expenses: Single, $1,500; Couple, $3,000. Note that for Medi-Cal, this $1,500 per person for burial expenses cannot be in a bank account. It must be invested in a burial policy.
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.
Your Income Is Below… (Note: does not include the $20 disregard.) | Your Assets Are at or Below2… | You Pay |
---|---|---|
135% of the FPL:
| Single: $10,590 Couple: $16,630 |
|
135% of the FPL:
| Single: $16,660
Couple: $33,240 |
|
150% of the FPL:
| Single: $16,660 Couple: $33,240 |
|
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. Note that for LIS, this exempt $1,500 per person for burial expenses can be in a bank account.