If you are qualified to receive Medicaid, you automatically qualify for the Medicare Part D Extra Help
program and the cost of your Medicare Part D premium will be covered up to a certain level – called your state’s Low-Income Subsidy (LIS) Benchmark Premium.
For example, if you live in a state with a benchmark premium of $25, the Medicare Part D
Extra Help program will pay for the premium up to this level (or slightly above) and you will have a $0 premium.
But, if your chosen Medicare Part D plan's monthly premium is over the benchmark amount
, or has a supplemental Part D premium
, you will be charged the additional cost. So, in this example, if you Medicare plan has a $30 monthly premium, you may be charged the $5 additional cost over your state's benchmark premium.
2021 LIS Benchmark Premiums
You can see a list of the 2021 Medicare Part D benchmark premiums for each state in our Blog: “2021 State Low-Income Subsidy Benchmark Premium Amounts - with a comparison of benchmark changes since 2006
Where to see if a Medicare Part D plan qualifies for a $0 premium
You can also see whether a Medicare Part D plan has a premium meeting the state’s LIS benchmark
using our Medicare Part D Plan Finder where we show all Part D plans available in each state and indicate whether the plans qualify for the $0 LIS benchmark premium.
Here is an example link to the 2021 California Medicare Part D plans:
We have a column showing "$0 Prem. with Full LIS?
" and plans that have a $0 premium are indicated with a "Yes" with a green background.
For example, using the link above, if you scroll down through the California plans, the 2021 “Cigna Secure Rx (PDP) - S5617-158
” shows a $27.70 premium and "Yes
" in the "$0 Prem. with Full LIS?". So for anyone who qualifies for full LIS, they would have a $0 premium because it meets the Low-Income Subsidy benchmark premium for California.
If a plan does not qualify
for the $0 Premium, the "$0 Prem. with Full LIS?" column will state "No
However, if you select your level of subsidy in the "LIS Subsidy Amount" question
in the criteria box, the premiums shown for all plans will be those corresponding to your level of subsidy. For example, when the 100% subsidy is checked you will note that the SilverScript Choice (PDP) shows a premium of $0.00 and the WellCare Medicare Rx Saver (PDP) shows a premium of $5.60
For more details on your Medicare Part D plan premium, you can speak with a Medicare representative who can look into your records and provide more information about why you are paying a premium.
You can telephone Medicare at 1-800-633-4227, select the prescription drug option, and then choose the option to speak with a Medicare representative or say "representative" several times during the automated menu options. Once connected, you can explain your situation to a Medicare representative and ask for assistance determining whether you are paying the correct premium.