Medicare Part D’s LIS, Extra Help programs are the same Covering The Bases

Medicare programs are very confusing! My mother lives off a small Social Security check and has no savings. She was told to apply for the LIS program to help her pay for her medicines. When I began to help her with pursuing the LIS program, I also learned of the Extra Help program. Could you clarify these programs?

You are correct - the programs (and their names) are confusing.

LIS, or Low Income Subsidy for Part D, and Extra Help for Part D are the same program. When Medicare Part D came into existence, federal agencies labeled this program with two names. For the sake of simplicity, we will use one term for our discussion: Extra Help.

People enrolled in a Medicare Part D plan incur costs:

*Part D plans have monthly premium costs; these premiums must be paid every month to be a member of a particular Part D drug plan.

*Part D plans may (may not) elect a deductible cost. A deductible is a dollar amount that a person would have to pay for their medicines before the Part D drug plan begins to help to off-set the cost of the medicines.

*Part D plans set co-payment amounts. Co-payments are the amount you must pay at the pharmacy counter to pick up your prescriptions. Co-payments are a fraction of the full cost of the medicine.

The Extra Help for Part D program is designed to help people who have limited income and limited assets with the above mentioned costs. A person's income and assets are screened.

There are varying levels of financial help available through the Extra Help program. A person approved for Extra Help may have their monthly premium fully subsidized, meaning they will have no monthly premium for Part D.

If they fall in the higher levels of income/assets under the Extra Help program, they may have a portion of their monthly premium subsidized.

Likewise, people approved for the Extra Help program will receive help with both the cost of the deductible (if a plan imposes a deductible) and with the cost of their co-payments at the pharmacy counter.

The 2016 income levels for Extra Help are below $1,505/month for an individual or below $2,023/month for a married couple.

The asset limits for the Extra Help program are below $13,640 for an individual or below $27,250 for a married couple. Assets do not include the home in which you reside, your car, your personal possessions or your life insurance policies.

The application for the Extra Help program is made through the Social Security Administration. You may apply online at www.ssa.gov/medicare/prescriptionhelp or call 1-800-772-1213 to request a paper application.

Your local SHIP office does have a limited supply of paper applications; you may call SHIP at 410-222-4257 for a paper application.

You may also talk with a SHIP counselor for more information about the Extra Help (a.k.a. LIS) program. SHIP may also help you in selecting the appropriate Part D drug plan to work with Extra Help assistance.

Amy Rubino is the director of the Senior Health Insurance Assistance Program and the Senior Medicare Patrol for the Anne Arundel County Department of Aging and Disabilities. You may contact either program at 410-222-4257 or [email protected].

Credit: Amy Rubino