If you are qualified to receive Medicaid, then 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, 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.
2018 LIS Benchmark Premiums
You can
see a list of the 2018 Medicare Part D benchmark premiums for each state in our Blog: “
2018 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 2018 California Medicare Part D plans (You can choose a link to view plans in another state):
PDPFinder.com/CA
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 2018 “
Symphonix Value Rx (PDP) - S0522-034” shows a $27.30 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 Symphonix Value Rx shows a premium of $0 and the Aetna Medicare Rx Select (PDP)
shows a premium of $1.30.
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.