Extra Help (Low-Income Subsidy)
Summary
Extra Help, also known as the Low-Income Subsidy (LIS), is a Medicare program that helps eligible individuals pay for prescription drug costs.
If you qualify, Extra Help can significantly reduce your out-of-pocket costs for covered prescription drugs and may lower or eliminate certain prescription drug expenses.
Many people who qualify for Extra Help automatically receive the benefit, while others may need to apply.
How Extra Help Can Lower Your Costs
Depending on your eligibility level, Extra Help may:
- Lower or eliminate your prescription drug deductible
- Reduce your copays for covered medications
- Lower your overall out-of-pocket prescription drug costs
- Provide financial assistance throughout the year
The amount of assistance you receive depends on your eligibility and subsidy level.
Who May Qualify?
You may qualify for Extra Help if you have limited income and resources.
Many people who receive certain government assistance programs are automatically enrolled in Extra Help.
Examples may include individuals who:
- Receive full Medicaid benefits
- Participate in a Medicare Savings Program
- Receive Supplemental Security Income (SSI)
Medicare determines eligibility and may change if your financial circumstances change.
Do I Need to Apply?
Many people are automatically enrolled and do not need to apply.
If you are not automatically enrolled, you may still qualify and can apply through Medicare or the Social Security Administration.
How Do I Know If I Have Extra Help?
If you qualify for Extra Help, you will receive information from Medicare explaining your subsidy level and how it affects your prescription drug costs.
Many members receive a Low-Income Subsidy (LIS) Rider that explains the prescription drug cost-sharing that applies to their coverage.
If you are unsure whether you receive Extra Help, Member Services can help.
Extra Help and Medicare & Medicaid
Many people who have both Medicare and Medicaid automatically qualify for Extra Help.
If you are enrolled in a plan for people who qualify for both Medicare and Medicaid, your prescription drug costs may be lower than those of members who do not receive Extra Help.
Need Help Paying for Prescription Drugs?
If you think you may qualify for Extra Help, resources are available to help you learn more about the program and determine your eligibility.