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Education and Decision Support Tools for the Medicare Community

Medicare, Medicaid, "Extra Help" and Low-Income Subsidy (LIS)

 As a reminder, Medicare is government sponsored health insurance for people
  • age 65 or older,
  • under age 65 with certain disabilities, and
  • any age person with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a kidney transplant).
  • Medicare Part A covers in-patient or hospital care (and more).
  • Medicare Part B covers out-patient or doctor visits (and more).
  • Medicare Part D covers out-patient prescription drugs (with some limitations).
  • Medicare Part C or Medicare Advantage plans implement Medicare Part A and Medicare Part B coverage and may include Medicare Part D coverage (and maybe more).
Medicaid is a joint Federal and State program helping people who have limited income and resources with medical costs. Medicaid programs vary from state to state, but most of your health care costs are covered if you qualify for both Medicare and Medicaid (also called dual-eligible). People with Medicaid may get coverage for services that are not fully covered by Medicare, such as nursing home and home health care (check with your state for more details). Who qualifies for the Medicaid program? The income limits for Medicaid vary from state to state. Contact your State Medical Assistance (Medicaid) office to see if you qualify.

How do I apply for the Medicaid program? You can contact your State Medical Assistance (Medicaid) office for more information about Medicaid benefits. You can also visit www.medicare.gov on the web or call 1-800-MEDICARE (1-800-633-4227) to get the telephone number for your State Medical Assistance office. TTY users should call 1-877-486-2048.

The Medicare Part D Extra Help or Low-Income Subsidy (LIS) program helps people with limited financial resources pay for their Medicare Part D prescription drug coverage. For more information, you can read below and see Extra help paying for Medicare prescription drug coverage If you receive Medicare Part D Extra Help, you may pay a lower or no monthly premium, a lower or no initial deductible, have coverage in the Donut Hole or Coverage Gap, and pay very little for your prescription drugs that are covered by your Medicare Part D plan.

If you qualify for Medicaid, you automatically qualify for the Medicare Part D "Extra Help" program that may lower the cost of your prescription drugs.

As we read above, there is financial extra help available to Medicare beneficiaries who have limited income and resources that pays for some health care and prescription drug costs . Depending on your income and resources, you might qualify for one or more of the following six programs:

  1. The low-income subsidy (LIS) program or Medicare Part D Extra Help paying for Medicare prescription drug coverage, see Extra help paying for Medicare prescription drug coverage
  2. Medicaid (help from your state), see Medicaid
  3. Medicare Savings Programs (help from your state Medicaid program paying Medicare premiums), see Medicare Savings Programs (help from Medicaid paying Medicare premiums)
  4. Supplemental Security Income (SSI) benefits, see Supplemental Security Income Benefits
  5. The PACE Program (Programs of All-inclusive Care for the Elderly), see PACE
  6. Programs for people who live in the U.S. Territories of Puerto Rico, the Virgin Islands, Guam, the Northern Mariana Islands, and American Samoa, see Programs for People who live in the U.S. Territories


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Tips & Disclaimers
  • 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.
  • We are an independent education, research, and technology company. We are not affiliated with any Medicare plan, plan carrier, healthcare provider, or insurance company. We are not compensated for Medicare plan enrollments. We do not sell leads or share your personal information.
  • 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 medicare.gov site. Beneficiaries can appoint a representative by submitting CMS Form-1696.
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