By Dana Barrett
\nWhat is the Extra Help Medicare Program?
\nSome low-income folks on Medicare qualify for the Limited Income Subsidy (LIS) more commonly referred to as the \u201cExtra Help Plan\u201d. This subsidy helps to pay prescription drug expenses not covered directly by Medicare Part D. The subsidy level is determined by the recipient\u2019s income when compared to the Federal Poverty Level including resource limits defined by the Social Security Act.
\nWhat are the Benefits of the Extra Help Medicare Plan?
\nIf you qualify for this low-income subsidy you\u2019ll have financial assistance to help with fees such as the Medicare Part D monthly premium, as well as any copayments or coinsurance. The subsidy also helps to offset your plan\u2019s annual deductible and eliminates the late penalty if you missed the initial enrollment period for applying for Medicare Part D.
\nIf you are eligible to use Extra Help, make sure that all your current prescriptions are included on your Part D plan\u2019s\u00a0list of covered medications and brands.\u00a0 It\u2019s important to note that you are also required to use pharmacies in your plan\u2019s\u00a0network. If you have a change in health conditions resulting in the need for new medication that isn\u2019t covered by your current Part D plan, you\u2019ll be eligible for a \u201cSpecial Election Period\u201d to make those changes.\u00a0
\nAs a quick review, it\u2019s worth highlighting that most people who qualify for Extra Help receive the following benefits:
\nWho Qualifies for the Extra Help Medicare Prescription Drug Plan?
\nMedicare participants who are also enrolled in Medicaid (dual eligibility) automatically qualify for the Extra Help Plan. As do individuals who qualify for a Medicare Savings Program, and also Medicare recipients who are receiving Supplemental Security Income. If you fall into any of these categories, you should receive a notice from the Centers for Medicare & Medicaid Services (CMS) to let you know that you aren\u2019t required to\u00a0apply\u00a0for the plan.
\nIf you are enrolled in Medicare or a Medicare Advantage Plan but don\u2019t meet any of these qualifications, then you\u2019re required to apply to Social Security for the Extra Help Plan. Remember that the Extra Help Plan (LIS) is not a substitute for Medicare Part D. You must be enrolled in Part D to qualify for the low-income subsidy.
\nHow is the Eligibility for the Limited-Income Subsidy Determined?
\nThe Centers for Medicare and Medicaid Services release guidelines that outline the income and asset thresholds for qualifying for either full or partial LIS help. Assets that count toward your resources include any real estate in your name that isn\u2019t your primary residence and also funds held in banks or investment accounts. Account assets that affect eligibility include:
\nIt\u2019s important to note that your home, car, and any insurance policies you own are not included in the calculation for eligibility. Income and asset limits to determine if you qualify are updated every year, so you may be eligible one year but not the next. For 2021 the requirements are listed below:
\nFull Subsidy
\nPartial Subsidy
\nAre Burial Assets Included in Eligibility Calculations?
\nAs outlined by the CMS, if any resource assets include burial costs then the resource limits increase slightly. This includes costs associated with the purchase or maintenance of a burial plot for either an individual or spouse or even a family plot. Any prepaid fees to a funeral home for burial services also qualify. The recipient is required to notify Social Security of these expenses to have their resource qualification adjusted.
\nFull Subsidy (with burial expense notification)
\nPartial Subsidy (with burial expense notification)
\nYou may also qualify if your income is above these limits, but you are financially responsible for other members of your family living in the same house.
\nIf you are currently enrolled in the (LIS) Extra Help Plan and you are concerned about potential changes to your coverage due to a mailing that you received from CMS or Social Security, you can find more information here regarding notices about changes to copayment levels, or if Medicare is switching you to a different plan. There is also help for automatic enrollees whose eligibility has ended, and those recipients who chose their own Medicare Part D plan.
\nIs the Annual Election Period the Same for LIS and Medicare?
\nWhen you qualify for the Extra Help Plan, you\u2019ll have access to a Special Enrollment Period (SEP) once per calendar quarter from January 1st until September 31st to either change to another prescription Part D plan or newly enroll for coverage. You are not allowed to use the Extra Help Special Enrollment Period from October through December because you can use the regular Fall Open Enrollment period if you need to make changes to your prescription drug plan.\u00a0
\nThe Take-Away
\nMedicare recipients may be eligible for the Extra Help Plan often referred to as the Part D Low-Income Subsidy, which is provided jointly by the CMS and the Social Security Administration. This plan was designed to protect low-income and fixed-income seniors from the somewhat costly and unpredictable out-of-pocket expenses for their essential prescription drugs.\u00a0
\nIf you are already a Medicare or Medicare Advantage recipient, it\u2019s easy to apply for the plan to find out if you qualify for low-income assistance. You can apply online at www.socialsecurity.gov/extrahelp, or call the Social Security Administration at 800-772-1213.\u00a0
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