Is there a difference between the Medicare Part D Low Income Subsidy (LIS) and the Medicare Part D "Extra Help" Program?
No. There is no difference between the Medicare Part D Low Income Subsidy (LIS) and the Medicare Part D "Extra Help" Program. We simply have two name for the same program. The Centers for Medicare and Medicaid Services (CMS or Medicare) have a tendency to call the program LIS when communicating with the insurance carriers, partner organizations and internally. In most communications with Medicare beneficiaries, CMS and SSA tend to refer to the program as "Extra Help" (for instance, you might receive a letter from CMS that says "You may be qualified for Extra Help").
Information for People Losing their Automatic Eligibility for the Extra Help
Medicare and/or Social Security mails a notice on gray paper in September to people who will no longer automatically qualify for the Low Income Subsidy program. This notice (CMS Publication No. 11198) explains why a person no longer automatically qualifies, and encourages them to complete and return an enclosed LIS application (a postage-paid pre-addressed envelope is also included). People may still qualify for this program, but they need to apply.
Information for People with a Change in their Extra Help Co-payment Level
Medicare mails a notice (CMS Publication No. 11199) on orange paper in early October to people who continue to qualify for extra help but will have a change in their co-payment level.
Information for People Medicare will Reassign to a New Plan for the Up Coming Plan Year
Medicare mails a notice on blue paper (CMS Publication No. 11208) in early November to people who continue to qualify for extra help but will be re-assigned to a new prescription drug plan starting January 1. Medicare is re-assigning people who meet three factors: 1.) qualify for the full (100%) premium subsidy, 2.) their prescription drug plan in raising their premium cost above the determined low-income premium amount, and 3.) Medicare enrolled them in the plan. Medicare is also re-assigning all people who qualify for the LIS program whose Medicare Prescription Drug Plans are leaving the Medicare Program. Medicare will mail this notice (CMS Publication No. 11208) on blue paper by early November.
Information for People Who Chose Their Own Plan
Medicare mails a notice (CMS Publication No. 11267) in early November to certain people whose premium cost will increase but Medicare isn’t re-assigning because they chose and joined their own plan. Medicare is mailing this notice to people who qualify for the full (100%) premium subsidy whose Medicare Prescription Drug Plan premium would increase above the determined low-income premium subsidy amount. This notice lets people know the cost for their drug plan premiums for the new plan year and their options to stay in their plan or join another plan, including plans for which they will pay no monthly premium.
The Medicare Advantage and Medicare Part D prescription drug plan data on our site comes directly from Medicare and is subject to change.
Medicare has neither reviewed nor endorsed the information on our site.
We provide our Q1Medicare.com site for educational purposes and strive to present unbiased and accurate information.
However, Q1Medicare is not intended as a substitute for your lawyer, doctor, healthcare provider, financial advisor, or pharmacist.
For more information on your Medicare coverage, please be sure to seek legal, medical, pharmaceutical, or financial advice from a licensed professional or telephone Medicare at 1-800-633-4227.
Benefits, formulary, pharmacy network, provider network, premium and/or co-payments/co-insurance may change on January 1 of each year.
Our PDP-Compare.com and MA-Compare.com provide highlights of annual plan benefit changes.
The benefit information provided is a brief summary, not a complete description of benefits. For more information contact the plan.
Limitations, copayments, and restrictions may apply.
We make every effort to show all available Medicare Part D or Medicare Advantage plans in your service area.
However, since our data is provided by Medicare, it is possible that this may not be a complete listing of plans available in your service
area. For a complete listing please contact 1-800-MEDICARE (TTY users should call 1-877-486-2048),
24 hours a day/7 days a week or consult www.medicare.gov.
When enrolling in a Medicare Advantage plan, you must continue to pay your Medicare Part B premium.
Medicare beneficiaries with higher incomes may be required to pay both a Medicare Part B and Medicare Part D Income Related Monthly Adjustment Amount (IRMAA). Read more on IRMAA.
Medicare Advantage plans that include prescription drug coverage (MAPDs) are considered Medicare Part D plans and members with higher incomes may be subject to the Medicare Part D Income Related Monthly Adjustment Amount (IRMAA), just as members in stand-alone Part D plans. In certain situations, you can appeal IRMAA.
You must be enrolled in both Medicare Part A and Part B to enroll in a Medicare Advantage plan. Members may enroll in a Medicare Advantage plan only during specific times of the year. Contact the Medicare plan for more information.
If you are enrolled in a Medicare plan with Part D prescription drug coverage, you may be eligible for financial Extra Help to assist with the payment of your prescription drug premiums and drug purchases. To see if you qualify for Extra Help, call: 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048, 24 hours a day/ 7 days a week or consult www.medicare.gov; 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; or your state Medicaid Office.
Medicare evaluates plans based on a 5-Star rating system. Star Ratings are calculated each year and may change from one year to the next.
A Medicare Advantage Private Fee-for-Service plan (PFFS) is not a Medicare supplement plan. Providers who do not contract with the plan are not required to see you except in an emergency.
Disclaimer for Institutional Special Needs Plan (SNP): This plan is available to anyone with Medicare who meets the Skilled Nursing Facility (SNF) level of care and resides in a nursing home.
Disclaimer for Dual Eligible (Medicare/Medicaid) Special Needs Plan (SNP): This plan is available to anyone who has both Medical Assistance from the State and Medicare.
Premiums, co-pays, co-insurance, and deductibles may vary based on the level of Extra Help you receive. Please contact the plan for further details.
Disclaimer for Chronic Condition Special Needs Plan (SNP): This plan is available to anyone with Medicare who has been diagnosed with the plan specific Chronic Condition.
Medicare MSA Plans combine a high deductible Medicare Advantage Plan and a trust or custodial savings account (as defined and/or approved by the IRS). The plan deposits
money from Medicare into the account. You can use this money to pay for your health care costs, but only Medicare-covered expenses count toward your deductible.
The amount deposited is usually less than your deductible amount, so you generally have to pay out-of-pocket before your coverage begins.
Medicare MSA Plans do not cover prescription drugs. If you join a Medicare MSA Plan, you can also join any separate (stand-alone) Medicare Part D prescription drug plan
There are additional restrictions to join an MSA plan, and enrollment is generally for a full calendar year unless you meet certain exceptions. Those who disenroll
during the calendar year will owe a portion of the account deposit back to the plan. Contact the plan provider for additional information.
Medicare beneficiaries may enroll through the CMS Medicare Online Enrollment Center located at www.medicare.gov.
Medicare beneficiaries can file a complaint with the Centers for Medicare & Medicaid Services by calling 1-800-MEDICARE 24 hours a day/7 days or using the
Beneficiaries can appoint a representative by submitting CMS Form-1696.