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…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: $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.