In this article ” 2021 LIS Requirements for Medicare Part D“, you will learn the small details which might save you a lot of money on your Prescription drugs. Let’s quickly go over some of the basics so that we are on the same page.
What is LIS?
LIS stands for Low-Income Subsidy, it is also known as “Extra Help“. LIS is a federal program that helps pay for some to most of the out-of-pocket costs of Medicare prescription drug coverage. This coverage on average is worth around $5,000 per year in savings for the average beneficiary.
What does " Extra Help" (LIS) cover?
The Extra Help program offers the following benefits:
- Pays for your Part D premium up to a state-specific benchmark amount
- Lowers the cost of your prescription drugs
- Gives you a Special Enrollment Period (SEP) once per calendar quarter during the first nine months of the year to enroll in a Part D plan or to switch between plans.
- Eliminates any Part D late enrollment penalty you may have incurred if you delayed Part D enrollment
Depending on your income and assets, you may qualify for either full or partial Extra Help. Both programs provide assistance with the cost of your drugs. To receive such assistance, your prescriptions should be on your plan’s formulary and you should use pharmacies in your plan’s network.
Remember that Extra Help is not a replacement for Part D or a plan on its own: You must still have a Part D plan to receive Medicare prescription drug coverage and Extra Help assistance. If you do not choose a plan, you will in most cases be automatically enrolled in one.
Who can get Extra Help?
Many people qualify for these big savings and don’t even know it. Anyone who has Medicare can get Medicare prescription drug coverage. Some people with limited resources and income also may be able to get Extra Help with the costs — monthly premiums, annual deductibles, and prescription co-payments
What are the income limits for Extra Help (LIS)?
To qualify for Extra Help, your annual income must be limited to $19,140 for an individual or $25,860 for a married couple living together.
Even if your annual income is higher, you may still be able to get some help.
What does NOT count as income?
Not all cash payments count as income. For example, don’t count:
- Supplemental Nutrition Assistance Program (food stamps).
- Housing assistance.
- Home energy assistance.
- Medical treatment and drugs.
- Disaster assistance.
- Earned income tax credit payments.
- Assistance from others to pay your household expenses.
- Victim’s compensation payments.
- Scholarships and education grants.
What is the resource limit for Extra Help (LIS)?
The 2021 resource limits are $7,970 ($11,960 if married) for the full low-income subsidy and $13,290 ($26,520 if married) for the partial low-income subsidies.
If beneficiaries notified the Social Security Administration (SSA) that they expect to use some of their resources for burial expenses, the 2021 resource limits are $9,470 ($14,960 if married) for the full low-income subsidy and $14,790 ($29,520 if married) for the partial low-income subsidies.
What is counted towards my resources when I apply?
Resources include the value of the things you own. Some examples are:
- Real estate (other than your primary residence).
- Bank accounts including checking, savings, and certificates of deposit.
- Bonds, including U.S. Savings Bonds.
- Mutual funds.
- Individual Retirement Accounts (IRAs).
- Cash at home or anywhere else.
What does NOT count as a resource?
Social Security does NOT count some of the following:
- Your primary residence.
- Your personal possessions.
- Your vehicle(s).
- Resources you couldn’t easily convert to cash, such as jewelry or home furnishings.
- The property you need for self-support, such as rental property or land you use to grow to produce for home consumption.
- Non-business property essential to your self-support.
- Life insurance policies.
- Burial expenses.
- Interest earned on money you plan to use for burial expenses.
How to apply for Extra Help
If you do not have Medicaid, Supplemental Security Income (SSI), or a Medicare Savings Program (MSP), you can apply for the Extra Help program through the Social Security Administration (SSA) using either the agency’s print or online application. If you already are on any of those programs, that means you already receive Extra Help.
To apply online, visit www.ssa.gov. Depending on processes in your state, this application can also serve to screen you for a Medicare Savings Program, which helps pay your Medicare costs. Be sure to complete the entire application and provide accurate information so you get all the benefits for which you qualify.
If your application for Extra Help is denied or you disagree with the award (for instance, you think that you should receive full Extra Help but you were only awarded partial Extra Help), you can appeal to SSA. You will have the opportunity to submit information about why you qualify when you appeal.