Medicare Extra Help for Low Income Persons

For individuals who receive Part D prescription drug coverage and are low-income, there is assistance available for the costs of deductibles and co-pays. This Extra Help is also known as the Low Income Subsidy (or LIS).

Who is eligible?
To receive Extra Help, persons must be eligible for Medicare Part D and have income less than 100% of the Federal Poverty Level for a full benefit or less than 150% of the Poverty Level for a partial benefit.

What are the benefits?
Benefits vary based on the recipient’s income and on living situation. In general, Extra Help will pay for a person’s monthly drug plan premium for an Extra Help approved plan. It will also pay the annual deductible amount ($480 in 2022), though it will leave $99 deductible for partial subsidy recipients to pay out of pocket. Extra Help will also cover all drugs in the coverage gap, or doughnut hole, or 85% of drug costs for partial subsidy recipients.  Individuals will pay $3.95/generic or multi-source drug and $9.85 for other drugs.

In the standard benefit, when Medicare beneficiaries have spent $4,430 in 2022 in prescription costs, the coverage gap begins; however, individuals who are receiving Extra Help will continue to pay co-payments between $3.95 for generic or multisource drugs with a retail price under $79 and 5% for those with a retail price greater than $79.  For brand-name drugs, beneficiaries would pay $9.85 for those drugs with a retail price under $197 and 5% for those with a retail price over $197.

Getting Extra Help with your Part D can

  1. Reduce your out-of-pocket costs for prescriptions
  2. Eliminate your monthly Part D premiums
  3. Reduce or eliminate your annual Part D deductibles
  4. Eliminate the coverage gap, also known as the donut hole.  This means your prescriptions won’t cost more just because you went over a spending limit in a particular year.

On average, Extra Help is estimated to save beneficiaries $5000 in prescription drug costs per year.

The variable benefits are summarized below:

Beneficiaries EligibleMaximum Income
(2021 Federal Poverty Levels)
Maximum Resources
Benefits (Deductibles, Co-pays, Out of pocket)
Institutionalized for more than 30 days in an assisted living, nursing home or hospital and receiving Medicaid.Deductibles and Co-pays $0.00
Income ≤ 100% Poverty
Premium in excess of $35.02
Name Brands-$4.00
Out of pocket-$0
Income > 135% Poverty
or Medicare Savings Program Enrollee
Premium in excess of $35.02
Name brands-$9.85
Out of pocket-$0
Non-institutionalized (Partial Subsidy)
Income ≤ 150% Poverty
Total out of pocket 15% (in doughnut hole)
Generics after doughnut hole-$3.95
Name brands after doughnut hole-$9.85

Individuals who in addition to Medicare, receive Medicaid, Supplemental Security Income or a Medicare Savings Program (Qualified Medicare Benefit – QMB, Qualified Individual 1 – QI-1, or Special Low Income Medicare Beneficiary – SLIM-B) will be automatically enrolled in Extra Help. Auto-enrollees may be asked for verification documentation of lawful presence, income and resources by their county department of social services.

Individuals who are not auto-enrolled must apply through the Social Security Administration or individuals can enroll over the phone (1-800-772-1213). To talk to a counselor about completing an application, call 303-333-3482.