Q1Medicare.com
Powered by Q1Group LLC
Powered by Q1Group LLC
Education and Decision Support Tools for the Medicare Community

Advertisement

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
< Previous
Next >
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".

FAQ Home
< Previous   Next >


Medicare Supplements
fill the gaps in your
Original Medicare
1. Enter Your ZIP Code:
» Medicare Supplement FAQs


Advertisement

Browse FAQ Categories
Q&A of the Day
Help! Where Do I Start?
General Medicare Part D (PDPs and MAPDs)
Medicare Advantage Plans (MAPD)
Medicare Supplements or Medigap
Medicare Savings Account Plans (MSA)
Choosing a Medicare Plan
Star Ratings & Medicare Plan Quality
Medicare Part D Enrollment
ANOC: Annual Plan Changes
Changing Medicare Part D Plans
Medicare Enrollment Periods (IEP and AEP)
Special Enrollment Periods (SEPs)
Medicare Plan Disenrollment
Late-Enrollment Penalty (LEP)
Initial Deductible
Cost-sharing: What You Pay
Paying Your Premiums
Extra Help - LIS - Medicaid
IRMAA: Higher Incomes and Costs
Living with Your Medicare Part D Plan
Explanation of Benefits (EOB)
Pharmacies and Part D
Retail Drug Pricing
Straddle Claims
Understanding Your Formulary
Monthly Formulary Changes
Drug Usage Restrictions (QL, PA, ST)
Formulary Exceptions (Coverage Determinations)
Transition Fills
Coverage of Specific Drugs
Diabetes and Diabetic Coverage
The Donut Hole or Coverage Gap
Entering the Donut Hole
Donut Hole Discounts
Closing the Coverage Gap
Exiting the Donut Hole
Catastrophic Coverage
TrOOP and MOOP: Out of Pocket Costs
Specific Healthcare Coverage
Supplemental Benefits
Your Healthcare Network
Medicare Plan Providers
Traveling with Your Medicare plan
Moving and Medicare Part D
Drug Discount Cards
Using Part D with Other Drug Programs
VA and TRICARE Coverage
Employer Drug Coverage
General Medicare
New Medicare Cards
Medicare Part B
Medicare Set Aside Arrangements
Medicare and the ACA Marketplace
Online Tool Tips
Other Q1Medicare Tips and Questions
Archive


Check for Savings Using a Drug Discount Card
Prescription Discounts are
easy as 1-2-3
  1. Locate lowest price drug and pharmacy
  2. Show card at pharmacy
  3. Get instant savings!
» Compare prices at pharmacies near you.
Your drug discount card is available to you at no cost.

Advertisement


© Q1Group LLC 2005 - 2022  

Advertisement


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.
.