California Health Advocates

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

California Health Advocates > Prescription Drugs > How to Qualify for Extra Help/Low-Income Subsidy (LIS) with Part D Costs

Eligibility for Extra Help/LIS for 2021

You are automatically enrolled in a drug plan with the Extra Help/Low-Income Subsidy (LIS) program for 2021 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…1You 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: $2,000

Couple: $3,000

  • No monthly premium
  • No annual deductible
  • Copayments of $1.30/generic and $4.00/brand name
The above applies until the end of the year if SOC is met before July 1. If SOC is met between July 1 and Dec 31, Extra Help remains until Dec of following year.

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: $7,970 Couple: $11,960

  • No monthly premium
  • No annual deductible
  • Copayments of $3.70/generic and $9.20/brand
    • name. No copayments during catastrophic coverage.

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: $1,449/mo., $17,388/yr.
  • Couple: $1,960/mo., $23,517/yr.
Single:
$9,470 Couple: $14,960
  • No monthly premium
  • No annual deductible
  • Copayments of $3.70/generic and $9.20/brand name
135% of the FPL:

 

  • Single: $1,449/mo., $17,388/yr.
  • Couple: $1,960/mo., $23,517/yr.
Single: $14,790

 

Couple: $29,520
  • No monthly premium
  • $92 annual deductible
  • 15% coinsurance; copayments up to $3.70/generic and $9.20/brand-name during catastrophic coverage
150% of the FPL:

 

  • Single: $1,610/mo., $19,320/yr.
  • Couple: $2,178/mo., $26,130/yr.
Single: $14,790

 

Couple: $29,520
  • Sliding-scale monthly premiums
  • $92 annual deductible
  • 15% coinsurance; copayments up to $3.70/generic and $9.20/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. Note that for LIS, this exempt $1,500 per person for burial expenses can be in a bank account.