If you are eligible for Medicare and having difficulties paying for your prescription drugs, you may want to learn more about the Medicare Part D
Extra-Help program by calling or visiting a local state Medicaid office or calling the Social Security Administration at 1-800-772-1213.
Extra Help or the Low Income Subsidy (LIS) is a government program that helps Medicare beneficiaries pay all or part of their monthly Medicare Part D drug plan premiums, deductibles, and may cover a significant portion of their prescription drug costs.
If you already qualify for Medicaid, you will automatically qualify for the Medicare Part D Extra Help and do not need to apply.
However, even if you do not meet the financial qualifications for your state Medicaid program, you may still qualify for Extra Help benefits based on your
annual income and
financial resources (or assets) - and save money on your prescription drugs.
No change in 2024 finances?
With changes in annual qualification requirements, you may now qualify for Extra Help.
Extra Help qualification limits change each year - and the 2024 income and resource limits for the Medicare Part D “Extra Help” program have recently been increased, so you may now be eligible for the “Extra Help” program --- even if you have not experienced changes in your financial situation.
Did the January increases in your 2024 Social Security benefits make you lose your Extra Help status?
You can reapply now for 2024 Extra Help.
Some people may have lost their Part D Extra Help benefits this past January when their monthly Social Security benefits increased pushing them above the Extra Help income limits, but these people are urged to re-apply for 2024 Extra Help now based on the newly released Extra Help qualification limits.
Extra Help based on Income and Assets
The income limits for Extra Help are based on the government's 2024
Federal Poverty Level (FPL) Guidelines that are adjusted each year and
include the following information:
- If your annual income is at or below 150% of FPL ($22,590 if you are single or $30,660
for married couples), you could qualify for the "full" Low-Income Subsidy (resource or asset limits also apply).
Question: Can I qualifying for partial-LIS benefits?
No. Partial-LIS no longer exists in 2024. The good news is
that, if you qualified for partial-LIS in 2023, you now qualify for 2024
full-LIS benefits. Plan year 2023 was the last year for partial Extra
Help. For plan year 2024 and beyond, the
Inflation Reduction Act (IRA)
increased full-Extra Help benefits to people at or below 150% of FPL
and consequently, the 2023 partial Extra Help (135% to 150% of FPL)
designation was eliminated.
Important: Again, even if you did not qualify for Extra Help last year, you may now qualify based on the new FPL Guidelines.
Full Low-Income Subsidy Income Requirements (150% of FPL)
using the 2024 Federal Poverty Level Guidelines (FPL) |
Persons
in Family |
48 Contiguous
States & D.C. |
Alaska |
Hawaii |
1 |
$22,590 |
$28,215 |
$25,965 |
2 |
$30,660 |
$38,310 |
$35,250 |
3 |
$38,730 |
$48,405 |
$44,535 |
4 |
$46,800 |
$58,500 |
$53,820 |
5 |
$54,870 |
$68,595 |
$63,105 |
6 |
$62,940 |
$78,690 |
$72,390 |
Learn more in our article,
2024 Federal Poverty Level Guidelines (FPL): 2024/2025 LIS Qualifications and Benefits.
Your tax return and changing financial status
Typically, the Extra Help application uses the most recent tax return
information sent to Social Security from the IRS. This would currently
be your 2022 tax return (filed in 2023). However, if you have
had significant changes in your income in comparison to your tax return,
you can appeal to Social Security to use more recent income figures.
Please see:
How to appeal the decision Social Security made on your application for Extra Help.
Qualifying for Medicaid and Medicaid Spend-down
As a reminder, Medicaid “Spend down” allows you to subtract your medical
expenses (for example, what you pay for your prescription medications)
from your annual income so that you might become eligible for your
state’s Medicaid program based on the cost of healthcare. In other
words, you may be eligible for your state’s Medicaid program based on
the principle of “Spend-Down”, even if you would otherwise earn too much
to qualify for Medicaid. You can
click here to read more about Medicaid Spend Down.
Extra Help status and changing 2024 Medicare Part D or Medicare Advantage plans.
If you qualify for Extra Help, you are granted a
Special Enrollment Period (SEP)
allowing you to change your Medicare plan once per quarter during the
first nine (9) months of the plan year. You can telephone a Medicare
representative at 1-800-Medicare (1-800-633-4227) for assistance finding
the most economical health and prescription drug coverage.