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What do I pay in Catastrophic Coverage if I qualify for Medicare Part D Extra Help or the Low-Income (LIS) program?

Category: Catastrophic Coverage
Updated: Mar, 14 2022
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What you pay in Catastrophic Coverage depends in your level of Extra Help.  If you are qualified for Medicare Part D Extra Help or the Low-Income Subsidy (LIS), you may have either full or partial LIS benefits - and your cost in the Catastrophic Coverage phase can vary slightly depending on your level of Extra Help - and this amount can vary year-to-year.

Full Extra Help: $0 in Catastrophic Coverage.  If you qualify for full-Extra Help or Low-Income Subsidy (LIS) benefits, you will have a $0 co-pay in the Catastrophic Coverage phase.

Less than full-LIS Benefits: Cost vary year-to-year.  If you receive 75% LIS benefits (between 135% and 150% of the Federal Poverty Level (FPL)), you will pay a portion on your drug costs while in Catastrophic Coverage.  For example, if you reach the Catastrophic Coverage phase and you receive 75% LIS benefits, you pay $3.70 in 2021 or $3.95 in 2022 for generic / preferred multi-source drugs and $9.20 in 2021 or $9.85 in 2022 for all other formulary drugs.

Catastrophic Coverage costs for full- and partial LIS beneficiaries can be found online in our table Medicare Part D Standard Benefit Model Plan Parameters under the bottom section "Maximum Copayments above Out-of-Pocket Threshold".

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