What is the Low Income Subsidy?
The Medicare Low Income Subsidy (LIS) is also known as Extra Help and is exactly what the name implies. It helps eligible individuals with limited income and resources on Medicare to pay for prescription drugs and lowers the costs of Medicare prescription drug coverage. This help takes the form of subsidies paid by the Federal government to the drug plan in which the Medicare beneficiary enrolls. The subsidy provides assistance with the premium, deductible and co-payments of the program. Beneficiaries may apply for the Low-Income Subsidy/Extra Help with the Social Security Administration (SSA) or with their State Medicaid agency. Medicare beneficiaries who wish to enroll in the Medicare Prescription Drug Program must choose a prescription drug plan through which to receive the benefit. The application for LIS/Extra Help does not enroll you in a Medicare Prescription Drug Plan. You do not need to be enrolled in a Medicare Prescription Drug Plan to file for LIS/Extra Help. You can apply for the LIS/Extra Help first, but the assistance does not start until you’re enrolled with an approved Medicare prescription drug provider. If you are enrolled in Medicaid, Supplemental Security Income (SSI), or a Medicare Savings Program (MSP), you automatically qualify for Extra Help regardless of whether you meet LIS/Extra Help’s eligibility requirements.
Summary Benefits of the Low Income Subsidy:
The Part D Low Income Subsidy/Extra Help program offers the following benefits:
- Pays for your Part D premium up to a state-specific benchmark amount. That can range from $42.43/month in New York to $25.10/month in Texas.
- Lowers the cost of your prescription drugs.
- Gives you a Special Enrollment Period (SEP) once per calendar quarter during the first nine months of the year to enroll in a Part D plan or to switch between plans. You cannot use the LIS/Extra Help SEP during the fourth calendar quarter of the year (October through December). You should use Fall Open Enrollment during this time to make prescription drug coverage changes.
- Eliminates any Part D late enrollment penalty you may have incurred if you delayed Part D enrollment.
Depending on your income and assets, you may qualify for either full or partial LIS/Extra Help. Both programs aid with the cost of your drugs. To receive such assistance, your prescriptions should be on your plan’s formulary and you should use pharmacies in your plan’s network.Remember that LIS/Extra Help is not a replacement for Part D or a plan on its own: You must still have a Part D plan to receive Medicare prescription drug coverage and LIS/Extra Help assistance. For people in this category, it has been estimated that the LIS/Extra Help is worth about $5,100 per year for the average person.
What is a Dual Eligible Plan?
People who qualify for both Medicare and Medicaid at the same time are “dual eligible”. Dual special needs plans are for people who could use some extra help. That may be because of income, disabilities, age and/or health conditions. Dual plans are a type of Medicare Advantage plan. Dual special needs plans are also called D-SNP. A dual special needs plan works together with your Medicaid health plan. You get to keep all the Medicaid benefits, but they also add more features than you get with Original Medicare. And all of these benefits come with a $0 plan premium.
How does Medicare and Medicaid work together?
Medicaid programs often cover benefits that aren’t offered by Medicare. Examples include dental, vision and hearing coverage, transportation assistance and long-term care. Paying for certain Medicare costs is another way Medicaid programs can help Medicare. The overall goal is for both Medicaid and Medicare to work together more effectively to improve care and lower costs. It’s the responsibility of the Medicare-Medicaid Coordination Office to make sure that people who are dually enrolled in both Medicare and Medicaid have full access to seamless, high quality health care.
Whether a Low Income Subsidy/Extra Help plan or a Dual Eligible Plan is right for you, check with Georgia Medicare Insurance today and get all the benefits you are entitled to!