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What is Extra Help or the Low-Income Subsidy (LIS)?

Category: Extra Help - LIS - Medicaid
Updated: Jan, 22 2023
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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.

If you receive Medicare Part D Extra Help, you may pay a lower - or $0 monthly premium, a lower or $0 initial deductible, have continuous coverage even through the Donut Hole or Coverage Gap, and pay very little for your prescription drugs that are covered by your Medicare Part D plan.

Extra Help eligibility is based on the income you earn and the financial resources you own - and the financial limits can change every year.

For example, in 2023, you will qualify for at least partial-Extra Help if your income is below $21,870 per year for a single person (or $29,580 for a married couple living together or even more if you have dependent children or grandchildren living with you), AND if your assets are below $16,660* for a single person (or $33,240* if you are married).  *includes the $1,500 burial allowance.


The following items are NOT included in the income calculation:
  • Housing assistance,
  • Medical treatment and drugs,
  • Food stamp assistance, etc.
The following items are included in resources (or assets):
  • bank accounts,
  • stocks and bonds,
  • Real estate (other than your primary residence), etc.
The following items are NOT included in resources:
  • the house you live in,
  • your car,
  • other personal possessions such as your furniture and jewelry, etc
Medicaid and Extra Help

If you qualify for your state's Medicaid program, you automatically qualify for the Medicare Part D "Extra Help" program that may lower the cost of your prescription drugs.  And if you are qualified for Medicaid and are automatically qualified for Extra Help, Medicare will mail you a letter about your Extra Help.  If you get one of these letters, keep it for your records.

You still need to join a Medicare Part D drug plan (PDP) or Medicare Advantage plan (MAPD) to get Medicare prescription drug coverage.


You may be automatically enrolled into a Medicare Part D plan

If you do not join a Medicare Part D drug plan, Medicare may enroll you into a plan to make sure you have drug coverage.  If Medicare enrolls you in a plan, Medicare will send you a letter explaining when your coverage begins.

If you want to choose your own Medicare Part D plan or do not want to join a Medicare Part D drug plan (for example, because you want to keep your employer or union coverage instead), you can call 1-800-MEDICARE (1-800-633-4227) or the plan listed in your letter and tell a Medicare representative you do not want to be in the Part D plan - or you would like to choose your own Medicare Part D plan coverage rather then the plan selected automatically.

Remember: you must be in a Medicare Part D drug plan (PDP or MAPD) to take advantage of the Extra Help program this extra help.

You may qualify for "Partial" Extra Help

Even if you do not qualify for 100% Extra Help, you may qualify for partial-Extra Help that still lowers the cost of your prescription drug coverage.  You can contact your local state Medicaid office for more information about partial Extra Help benefits.  You can click on the text and read more about Medicaid, LIS, & Extra Help.

Keep in mind that 2023 is the last year for partial-Extra Help.  For plan year 2024 and beyond, the Inflation Reduction Act (IRA) of 2022 increases full-Extra Help benefits to people at or below 150% of FPL and consequently, the current partial-Extra Help (135% to 150% of FPL) designation will be eliminated.


Is there any difference between Extra Help and the Low-Income Subsidy?

No,  . . . and you can click here to read more . . .


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