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

Eligibility for Extra Help/LIS for 2019

You are automatically enrolled in a drug plan with the Extra Help/Low-Income Subsidy (LIS) program for 2019 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: $7,730

Couple: $11,600

  • No monthly premium
  • No annual deductible
  • Copayments of $1.25/generic and $3.80/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: $7,730

Couple: $11,600

  • No monthly premium
  • No annual deductible
  • Copayments of $3.40/generic and $8.50/brand name
More than 135% of the FPL and you met your Medi-Cal share of cost (SOC) any single month since July 1, 2019:

  • Single: >$1,406/mo., $16,861.50/yr.
  • Couple: >$1,903/mo., $22,828.50/yr.
Single:
$2,000Couple: $3,000
  • No monthly premium
  • No annual deductible
  • Copayments of $1.25/generic and $3.80/brand name

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.

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: $1,406/mo., $16,861.50/yr.
  • Couple: $1,903/mo., $22,828.50/yr.
Single:
$9,230 Couple: $14,600
  • No monthly premium
  • No annual deductible
  • Copayments of $3.40/generic and $8.50/brand name
135% of the FPL:

  • Single: $1,406/mo., $16,861.50/yr.
  • Couple: $1,903/mo., $22,828.50/yr.
Single: $14,390

Couple: $28,720

  • No monthly premium
  • $85 annual deductible
  • 15% coinsurance; copayments up to $3.40/generic and $8.50/brand-name during catastrophic coverage
150% of the FPL:

  • Single: $1,561/mo., $18,735/yr.
  • Couple: $2,114/mo., $25,365/yr.
Single: $14,390

Couple: $28,720

  • Sliding-scale monthly premiums
  • $85 annual deductible
  • 15% coinsurance; copayments up to $3.40/generic and $8.50/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.