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

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Eligibility for Extra Help/LIS for 2014

You are automatically enrolled in a drug plan with the Extra Help/Low-Income Subsidy (LIS) program for 2014 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 Below… You Pay

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

Single: $7,160

Couple: $10,750

  • No monthly premium
  • No annual deductible
  • Copayments of $1.20/generic and $3.60/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: $7,160

Couple: $10,750

  • No monthly premium
  • No annual deductible
  • Copayments of $2.55/generic and $6.35/brand name

More than 135% of the FPL and you met your Medi-Cal share of cost (SOC) any single month since July 1, 2013:

  • Single: >$1,313/mo., $15,755/yr.
  • Couple: >$1,770/mo., $21,236/yr.

Single:
$2,000

Couple: $3,000

  • No monthly premium
  • No annual deductible
  • Copayments of $2.55/generic and $6.35/brand name

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 Self-Enrollment Income/Asset Levels & Costs
Your Income Is Below… Your Assets Are at or Below2 You Pay

135% of the FPL:

  • Single: $1,313/mo., $15,755/yr.
  • Couple: $1,770/mo., $21,236/yr.

Single:
$8,660

Couple: $13,750

  • No monthly premium
  • No annual deductible
  • Copayments of $2.55/generic and $6.35/brand name

135% of the FPL:

  • Single: $1,313/mo., $15,755/yr.
  • Couple: $1,770/mo., $21,236/yr.

Single: $13,440

Couple: $26,860

  • No monthly premium
  • $63 annual deductible
  • 15% coinsurance; copayments up to $2.55/generic and $6.35/brand-name during catastrophic coverage

150% of the FPL:

  • Single: $1,459/mo., $17,505/yr.
  • Couple: $1,966/mo., $23,595/yr.

Single: $13,440

Couple: $26,860

  • Sliding-scale monthly premiums
  • $63 annual deductible
  • 15% coinsurance; copayments up to $2.55/generic and $6.35/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.

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Updated Feb 4, 2014

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