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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.

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Do you have comments or concerns about your Medicare coverage? Issues regarding getting your needed prescriptions from your Part D plan, or a Medicare Advantage plan representative's marketing practices? Let us know at comments@cahealthadvocates.org.

We are dedicated to making Medicare's program work well for all beneficiaries. Your feedback from your own or your client's concerns and experiences with Medicare, will guide our Medicare advocacy efforts with key policy and decision-makers in both California and nationally with the Centers for Medicare and Medicaid Services (CMS) and Congress.

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