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Extra Help

Extra Help, also called Low-Income Subsidy (LIS), is a Medicare program to help people with limited income and resources pay for their Medicare prescription drugs, premiums, deductibles, co-payments and coinsurance. Additionally, those who qualify will not have a coverage gap or late enrollment penalty.

To See if You Qualify, Call:

  • Call the Social Security Office at 1-800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday. TTY users should call 1-800-325-0778
  • Go online at www.ssa.gov/prescriptionhelp
  • Visit your state Medicaid office or local Social Security Administration office

Applications can take up to 60 days for processing.

View valid evidence of low income eligibility (Best Available Evidence).

Get more information on Best Available Evidence from Medicare.

Documents

Learn how to submit your proof of eligibility for Prescription Drugs Extra Help:

See what the monthly plan premiums are for those who qualify for Extra Help.

Helpful Information

Extra Help Details

If you get Extra Help from Medicare to pay for your Medicare Prescription Drug Plan costs, your monthly Part D plan premium may be lower than what it would be if you did not get Extra Help from Medicare. The amount of Extra Help you get will determine your total monthly Part D plan premium as a member of our plan.

Generic and Brand-Name Prescription Co-Payments
Most of our members get “Extra Help” with their prescription drug costs. If you receive “Extra Help”, your co-payment amount depends on the level of “Extra Help” you receive. You will either:

  • Pay a $0 (generic and brand) co-payment
  • or Pay a $1.25 (generic) or $3.70 (brand) co-payment
  • or Pay a $3.35 (generic) or $8.35 (brand) co-payment
  • or Pay a 15% coinsurance of the drug cost

Premiums
You must continue to pay your Medicare Part B premium (unless your Part B premium is paid for you by Medicaid or another third party).

Premiums, deductibles and co-payments may vary based on the level of Extra Help you receive. Contact us for details.

State Pharmacy Assistance Programs
A State Pharmaceutical Assistance Program (SPAP) helps people pay their monthly prescription drug plan premiums, deductibles, co-payments and coinsurance. For most programs, members must meet specific criteria to be eligible.

To find out if there is an SPAP in your state, please review the Evidence of Coverage or call your State Health Insurance Assistance Program (SHIP).

Medicaid
Medicaid is a joint federal and state program that helps pay medical costs for some people with limited income and resources.  

  • Most health care costs are covered if you have Medicare and Medicaid.
  • Medicaid programs (and income limits) vary from state to state.
  • Medicaid may offer coverage for services that aren’t fully covered by Medicare, such as nursing home and home health care.
  • Extra Help Details

    Extra Help Details

    If you get Extra Help from Medicare to pay for your Medicare Prescription Drug Plan costs, your monthly Part D plan premium may be lower than what it would be if you did not get Extra Help from Medicare. The amount of Extra Help you get will determine your total monthly Part D plan premium as a member of our plan.

    Generic and Brand-Name Prescription Co-Payments
    Most of our members get “Extra Help” with their prescription drug costs. If you receive “Extra Help”, your co-payment amount depends on the level of “Extra Help” you receive. You will either:

    • Pay a $0 (generic and brand) co-payment
    • or Pay a $1.25 (generic) or $3.70 (brand) co-payment
    • or Pay a $3.35 (generic) or $8.35 (brand) co-payment
    • or Pay a 15% coinsurance of the drug cost

    Premiums
    You must continue to pay your Medicare Part B premium (unless your Part B premium is paid for you by Medicaid or another third party).

    Premiums, deductibles and co-payments may vary based on the level of Extra Help you receive. Contact us for details.

    State Pharmacy Assistance Programs
    A State Pharmaceutical Assistance Program (SPAP) helps people pay their monthly prescription drug plan premiums, deductibles, co-payments and coinsurance. For most programs, members must meet specific criteria to be eligible.

    To find out if there is an SPAP in your state, please review the Evidence of Coverage or call your State Health Insurance Assistance Program (SHIP).

    Medicaid
    Medicaid is a joint federal and state program that helps pay medical costs for some people with limited income and resources.  

    • Most health care costs are covered if you have Medicare and Medicaid.
    • Medicaid programs (and income limits) vary from state to state.
    • Medicaid may offer coverage for services that aren’t fully covered by Medicare, such as nursing home and home health care.
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Y0070_WCM_06390E CMS Approved 10/23/2017 Last Updated On: 10/1/2017