Medicare offers a program called Extra Help to people with low incomes and limited assets. This is sometimes called Low Income Subsidy or LIS.
How to apply for Extra Help
You may automatically receive Extra Help
If you aren’t already getting Extra Help, see if you qualify by calling
Best Available Evidence policy
Counting your assets
Prescription drug benefits for members receiving Extra Help from Medicare
Medicare premium amounts for members receiving Extra Help
State Pharmaceutical Assistance Programs
Step 1: Choose a drug plan provider
Whether you qualify for Extra Help or not, you must enroll for prescription drug coverage in order to apply for Extra Help.
Step 2: Complete an application for Extra Help
The easiest way to apply is to download an application - Opens in a new window and submit it online. You can also fill out a paper copy. If you haven't already received a copy of the application by mail, request one toll-free at 1-800-772-1213, 7 am to 7 p.m., Monday through Friday. TTY: 1-877-325-0778.
Mail completed applications to:
Social Security Administration
Wilkes-Barre Data Operations Center
P.O. Box 1020
Wilkes-Barre, PA 18767-9910
After submitting your application, you'll hear within 8 weeks if you qualify for Extra Help with Part D costs.
If you meet any one of the criteria below, you will automatically receive Extra Help from Medicare to help with your Part D costs. There's no need to apply.
- You receive both Medicare and Medicaid.
- You receive both Supplemental Security Income (SSI) benefits and have Medicare.
- The state pays your Medicare premiums.
- 1-800-Medicare (toll-free; TTY/TDD users call 1-877-486-2048), 24 hours a day/7 days a week,
- Your State Medicaid Office, or
- The Social Security Administration toll-free at 1-800-772-1213. TTY/TDD users should call 1-800-325-0778 between 7 a.m. and 7 p.m., Monday through Friday.
If you have any questions, please contact UnitedHealthcare Customer Service.
The federal Best Available Evidence (BAE) policy - Opens in a new window requires that the plan adjust your subsidy if you provide updated information that changes the level of Extra Help you receive. A memo - Opens in a new window on the CMS website explains the procedures for updating a person's level of Extra Help.
To determine your eligibility, Medicare may also look at your assets. Assets Medicare counts include:
- Cash (including checking and savings accounts)
- Certificates of deposit
- Retirement accounts (like IRAs or 401(k)s)
- Stocks, bonds and mutual funds
- Promissory notes
- Property that could be converted to cash within 20 days.
- Life insurance policies
Medicare does not count these assets:
- Your primary home
- Your primary car
- Burial plots or agreements
- Funds set aside for burial expenses (up to $1,500 per person)
1Note: The income and resource limit amounts are for 2019. Either of these amounts can change each year. Income amounts will vary for Hawaii and Alaska.
2 If you choose a plan that has a premium at or under the amount Medicare has agreed to pay (CMS benchmark), your plan premium will be $0. If you choose a plan which has a premium above the amount Medicare has agreed to pay, your premium will be the difference between the amount Medicare has agreed to pay and the plan’s premium. See the 2018 benchmarks below. The amount Medicare has agreed to pay is subject to change annually.
Please note that the premiums listed do not include any Part B premium that you may be responsible for paying. Premiums listed are for both medical services and prescription drug benefits (MAPDs only).
3 For the first $66 in drug costs, assigned copay or 100% of drug costs, whichever is lower. Subsidies for United States Territories (Puerto Rico, U.S. Virgin Islands, Guam, American Samoa and Northern Mariana Islands) that have low income assistance available may be different than those stated in the chart above.
A State Pharmaceutical Assistance Program (SPAP) provides state-funded prescription drug assistance to people who need help paying for their monthly prescription drug plan premiums, deductibles, copays and coinsurance.
For most programs, members must meet specific income guidelines and additional requirements that vary by state.
To find out how to contact your state SPAP, visit www.medicare.gov/pharmaceutical-assistance-program/state-programs.aspx - Opens in a new window
All UnitedHealthcare Medicare prescription drug plans coordinate assistance with these states' programs: