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

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Eligibility for Extra Help/LIS for 2010

You are automatically enrolled in a drug plan with the Extra Help/Low-Income Subsidy (LIS) program for 2010 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… Your Assets Are at or Below1… You Pay

Under 100% of the federal poverty level (FPL):

Single: $8,100
Couple: $12,910
  • No monthly premium
  • No annual deductible
  • Copayments of $1.10/generic and $3.30/brand name
Note: If you have Medi-Cal and are living in a nursing home, you will have no drug copayments.

More than 100% but less than 135% of the FPL:

Single: $8,100
Couple: $12,910
  • No monthly premium
  • No annual deductible
  • Copayments of $2.50/generic and $6.30/brand name

More than 135% of the FPL and you met your Medi-Cal share of cost (SOC) any single month since July 1, 2009:

  • Single: $1,218/month, $14,621/year
  • Couple: $1,639/month, $19,670/year

Single:
$2,000 Couple: $3,000
  • No monthly premium
  • No annual deductible
  • Copayments of $2.50/generic and $6.30/brand name

If you do not meet the qualifications in the chart above, you can apply2 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 Self-Enrollment Income/Asset Levels & Costs
Your Income Is Below… Your Assets Are at or Below1… You Pay

135% of the FPL:

  • Single: $1,218/month, $14,621/year
  • Couple: $1,639/month, $19,670/year

Single:
$8,100 Couple: $12,910
  • No monthly premium
  • No annual deductible
  • Copayments of $2.40/generic and $6/brand name

135% of the FPL:

  • Single: $1,218/month, $14,621/year
  • Couple: $1,639/month, $19,670/year

Single: $12,510 Couple: $25,010
  • No monthly premium
  • $63 annual deductible
  • 15% coinsurance; after your true out-of-pocket (TrOOP) expenses exceed $4,550, you will have copayments of $2.50/generic and $6.30/brand-name

150% of the FPL:

  • Single: $1,354/month, $16,245/year
  • Couple: $1,821/month, $21,855/year

Single: $12,510 Couple: $25,010
  • Sliding-scale monthly premiums
  • $63 annual deductible
  • 15% coinsurance; after your TrOOP expenses exceed $4,550, you will have copayments of $2.50/generic and $6.30/brand-name

1Asset limit includes the allowed amount for burial expenses: Single, $1,500; Couple, $3,000.
2You must also enroll in a Medicare Part D drug plan if you qualify for Extra Help/LIS.

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Updated Jan. 8, 2010

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