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Medicare offers Extra Help (sometimes called Low Income Subsidy or LIS) to people with low incomes and limited assets. If you qualify, you’ll get help with drug costs that Medicare doesn't cover. Depending on your income and resources, you could save an average of $4,0001 per year.
Less than half of the people eligible for Extra Help sign up. If you think you might qualify, submit an application.
Do I qualify for Extra Help?
To be eligible for help with drug costs, you must:
Live in the United States or District of Columbia.2
Qualify for Medicare Part A and/or be enrolled in Medicare Part B.
Have less than $18,210 in annual income/$14,100 in assets (if single).3
Have less than $24,690 in annual income/$28,150 in assets (if married).3
2Programs may vary if you live in Puerto Rico, U.S. Virgin Islands, Guam, American Samoa or the Northern Mariana Islands. Income amounts will vary for Hawaii and Alaska.
3If you have more or less than these amounts, you still may qualify for Extra Help. The resource limits include $1,500 per person for burial expenses. These amounts may change each year. See Counting income and assets to see what is and is not included.
Single:
Income less than $15,079.5>, assets less than $8,440
Married:
Income less than $20,425.50, assets less than $13,410
Single:
Income less than $18,210. Assets more than $9,060 but less than $14,100
Married:
Income less than $24,690 Assets more than $14,340 but less than $28,150
$02
$83
After deductible is met, assigned cost share or 15% of drug costs3, whichever is lower
$3.35 generic or $8.35 brand name after $5,000 out-of-pocket for drugs in 2018
Single:
Income less than $18,210, assets less than $14,100
Married:
Income less than $24,690, assets less than $28,150
Discounted premium (sliding scale based on income)
$83
After deductible is met, assigned cost share or 15% of drug costs3, whichever is lower
$3.30 generic or $8.25 brand name after $4,950 out-of-pocket for drugs in 2017
Optional Title
1Note: The income and resource limit amounts are for 2018. 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).
Medicare premium amounts for members receiving Extra Help (CMS benchmarks by state)
State
Subsidy
Region
AK
32.92
34
AL
30.62
12
AR
22.56
19
AZ
32.88
28
CA
35.51
32
CO
34.18
27
CT
35.58
2
DC
30.70
5
DE
30.70
5
FL
29.07
11
GA
24.53
10
HI
25.38
33
IA
33.99
25
ID
40.24
31
IL
27.50
17
IN
31.24
15
KS
31.43
24
KY
31.24
15
LA
30.92
21
MA
35.58
2
MD
30.70
5
ME
34.27
1
MI
33.28
13
MN
33.99
25
MO
29.99
18
MS
25.81
20
MT
33.99
25
NC
30.16
8
ND
33.99
25
NE
33.99
25
NH
34.27
1
NJ
35.97
4
NM
24.60
26
NV
27.08
29
NY
38.98
3
OH
31.95
14
OK
29.65
23
OR
34.58
30
PA
37.18
6
RI
35.58
2
SC
23.03
9
SD
33.99
25
TN
30.62
12
TX
24.59
22
UT
40.24
31
VA
30.05
7
VT
35.58
2
WA
34.58
30
WI
40.04
16
WV
37.18
6
WY
33.99
25
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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.
How to apply for Extra Help
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.
You may automatically receive Extra Help
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.
If you aren't getting Extra Help, you can see if you qualify by calling:
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.
State Pharmaceutical Assistance Programs
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.
