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Low Income Subsidy (LIS) vs Extra Help

 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 Copayment 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 copayment 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.

See: CMS Guide to LIS Mailings for details on these and other mailings

If you receive Extra-Help (also known as LIS) or are dual eligible for Medicare and Medicaid, there are Medicare Prescription Drug plans in your state that will qualify for the $0 monthly premium. Click on your state below to see PDP plans that qualify for the $0 premium:
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  • 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.
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  • 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.
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  • 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 medicare.gov site. Beneficiaries can appoint a representative by submitting CMS Form-1696.
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