The Low-Income Subsidy (LIS) program
Do you ever have difficulty paying for your prescription drugs? Do you have limited income and assets? If you answered “yes” to either of these questions and you are a person with Medicare, Extra Help may be available for you.
The Low-Income Subsidy (LIS) program, also known as Extra Help, assists qualified Medicare beneficiaries with out-of-pocket expenses associated with Medicare Part D prescription drug expenses. There are more than 70,000 Medicare beneficiaries in North Carolina who may be eligible for this program but have yet to apply. The Seniors’ Health Insurance Information Program—or SHIIP— is a division of the N.C. Department of Insurance that can help beneficiaries understand and apply for this assistance.
“Many North Carolinians are not even aware that this assistance is available to them,” said Insurance Commissioner Wayne Goodwin. “SHIIP can help people with Medicare understand what they may be qualified to receive.”
To qualify for Extra Help, a Medicare beneficiary must meet certain income, resource and asset level requirements. The income and asset limits for Extra Help are $1,458.75 per month with assets up to $13,440 if you are single, and $1,966.25 per month with assets up to $26,860 if you are married.
Income includes monthly earnings, Social Security and Veterans’ benefits, disability payments, cash contributions, retirements and pensions. Resources and assets include the value of items that the person owns, such as cash, stocks, bonds, retirement accounts, the value of a second car, boats and any real property that is not the primary residence and does not produce income. Resources do not include appliances and other household furnishings, clothing or other personal items, such as jewelry. Assets excluded from the evaluation process are a home, all property attached to the home, personal belongings, one vehicle and irrevocable burial contracts and plots.
Depending on your income and asset levels and the Part D plan you choose, you may have either a reduced premium or no premium; your deductible may be covered or lowered; and your prescription copayments will be very small – from $2.55 for a generic drug and up to $6.35 for a brand-name drug. But perhaps the two biggest benefits to any amount of Extra Help/LIS assistance will be the elimination of a Part D coverage gap, also known as the “donut hole,” and the opportunity to change Prescription Drug Plans at any time.
When you apply for Extra Help through Social Security’s website, you can also choose the option to apply for Medicare Savings Programs during the online application process. The SHIIP office can assist you with applying online for the Extra Help program and, subsequently, the Medicare Savings Programs through the Social Security Administration website at www.socialsecurity.gov. Medicare beneficiaries may also apply online themselves or by contacting the Social Security Administration at 1-800-772-1213.