If your income and assets are below a certain level, you may qualify for Extra Help, also known as Low-Income Subsidy (LIS), a federal assistance program that helps pay for prescription drug costs. How much you pay for your prescription drugs and monthly premium depends on whether you have full or partial Extra Help.
In 2020, you qualify for full Extra Help if your income is up to $1,469 ($1,980 for couples) per month and your assets are up to $9,470 ($14,960 for couples). You will pay nothing for your monthly premium and deductible as long as your Part D plan has a premium at or below the Extra Help premium limit for your area. You pay a $3.70 copay for generic drugs and an $9.20 copay for brand-name drugs.
In 2021, you qualify for partial Extra Help if your income and assets are above the full Extra Help limits, your income is below $1,630 ($2,198 for couples) per month and you have up to $14,790 ($29,520 for couples) in assets. Your monthly premium depends on your income and you have a $92 deductible or your plan’s standard deductible, whichever is cheaper. At the pharmacy, you pay a 15 percent coinsurance or the plan copay, whichever is less.
If you do not already have Part D, enrolling in Extra Help will automatically enroll you in a Medicare Part D plan. You can choose to change plans later if you wish. Extra Help will eliminate any Part D penalty you have if you delayed Part D enrollment and did not have creditable coverage. Extra Help allows you to change your Part D coverage up to once per calendar quarter for the first three quarters of the year. During the last quarter, you must use the Annual Enrollment Period to make changes to your Part D coverage.
Some states may also have a State Pharmaceutical Assistance Program (SPAP) that helps pay the cost of your drugs. Note that not all states have an SPAP. For states that do have an SPAP, each program may have specific eligibility requirements, application instructions, and rules and conditions that a beneficiary must follow in order to get the benefit. The best way to learn whether your state has an SPAP is to contact your SHIP to find out if there is an SPAP in your state.
You can find your SHIP’s contact information by going to www.shiptacenter.org
Read Next: How Does the Medicare Part D Prescription Drug Benefit Work?
Find Out: What Is the Medicare Part D Coverage?
Return to: Medicare Part D
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