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

FAQs on Extra Help - LIS - Medicaid



Browse the Most Viewed and Newest Medicare Part D FAQs
If you still have questions, please contact us through our Online Help Desk.

Category: Extra Help - LIS - Medicaid


Most Viewed FAQs in Category
What is SLMB or a Specified Low Income Medicare Beneficiary?
SLMB is one type of Medicare Savings Program for the "Specified Low - Income Medicare Beneficiary" and, according to the Centers for Medicare and Medicaid Services (CMS), SLMB is defined as: "A Medic . . .

What is the Qualified Medicare Beneficiary (QMB) program and how can it save me money?
The Qualified Medicare Beneficiary (QMB) program is one of four Medicare Savings Programs (QMB, SLMB, QI, and QDWI) established by Medicare to help low-income Medicare beneficiaries pay their Medicare . . .

I am on Medicaid and Medicare assigned me a Part D plan that does not cover one of my medications. What do I do?
You have two options: You can select a new Medicare Part D plan that covers all of your medications. Medicaid and "Extra Help" recipients both receive a continuous Special Enrollment Period and ca . . .

How can I get financial "extra help" with my medication or Medicare Part D prescription drug costs?
To apply for the Medicare Part D Extra Help program you can: call the Social Security Administration about the Extra Help program at 1-800-772-1213, Monday through Friday between 7 am an . . .

What are the Federal Poverty Level (FPL) Guidelines?
The Federal Poverty Level (FPL) Guidelines determine the income level requirements for people applying for the Medicare Part D Low Income Subsidy (LIS) or Extra Help program. The Medicare Part D E . . .

What is a Medicare Savings Program?
A Medicare Savings Program (MSP) is one of four different Medicaid programs (QMB, SLMB, QI, QDWI) available for people with limited financial resources and, depending on a person's income and assets, . . .

Is Lifeline (personal response system) a covered benefit under Medicare if there is a medical indication for it?
No, your Medicare coverage does not include Lifeline or any other Personal Emergency Response or Alert System as a benefit. It is possible that Medicaid or another state agency will cover Lifeline . . .

What is a Medicare Advantage Medicare-Medicaid Plan (MMP)?
A Medicare Advantage Medicare-Medicaid Plan (MMP) is a private health plan designed to provide integrated and coordinated Medicare and Medicaid benefits for dual eligible Medicare beneficiaries. Un . . .

How often do I need to apply for the extra help?
Your eligibility will be reviewed every year to see if you still qualify for extra help.If you do qualify, you don’t need to reapply because the review will be sent to you automatically.However, . . .

Are there any Medicare Part D prescription drug plans that are free for Medicare beneficiaries who receive Medicaid or Extra Help?
No.  There are no Medicare Part D plans that are totally "free" to low-income Medicare beneficiaries, but there may be no (or a low) monthly premium, no deductible, no Coverage Gap, and very low . . .

Newest FAQs in Category
What is Extra Help?
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 Pa . . .

If I receive Medicare Part D Extra Help, will I enter the Donut Hole?
No.  If you are qualified for the Medicare Part D Extra Help program or Low-Income Subsidy (LIS), then you will never enter the Donut Hole or Coverage Gap and the cost of your prescriptions wil . . .

Can I change my Medicare Part D plan at any time if I qualify for Extra Help or the Low-Income Subsidy?
Yes.  If you are eligible for the Medicare Part D Extra Help or the Low-Income Subsidy (LIS) program, you are granted a "continuous" Special Enrollment Period (SEP) and can change Medicare Part . . .

I am qualified for Medicaid and Medicare, so why am I still paying a premium for my Medicare Part D prescription drug plan?
If you are qualified for your state's Medicaid program, then you automatically qualify for the Medicare Part D Extra Help program and the cost of your monthly Medicare Part D premiums will be covered . . .

If I am Dual Eligible and qualify for Extra Help, will my Medicare Part D drug plan premium always be $0?
Not always.  If you are "Dual Eligible", qualifying for both Medicare and Medicaid, you will automatically qualify for the Medicare Part D full Low-Income Subsidy (LIS) or Extra Help program. . . .

What is a Medicare Advantage Medicare-Medicaid Plan (MMP)?
A Medicare Advantage Medicare-Medicaid Plan (MMP) is a private health plan designed to provide integrated and coordinated Medicare and Medicaid benefits for dual eligible Medicare beneficiaries. Un . . .

I am supposed to receive Extra Help so why does my Medicare Part D coverage have an initial deductible?
If you are eligible for the Medicare Part D Extra Help or Low-Income Subsidy program, you should pay only a small co-payment for prescriptions covered by your Medicare plan, and, depending on your lev . . .

What is a Medicare Savings Program?
A Medicare Savings Program (MSP) is one of four different Medicaid programs (QMB, SLMB, QI, QDWI) available for people with limited financial resources and, depending on a person's income and assets, . . .

What is SLMB or a Specified Low Income Medicare Beneficiary?
SLMB is one type of Medicare Savings Program for the "Specified Low - Income Medicare Beneficiary" and, according to the Centers for Medicare and Medicaid Services (CMS), SLMB is defined as: "A Medic . . .

I am on Medicaid and Medicare assigned me a Part D plan that does not cover one of my medications. What do I do?
You have two options: You can select a new Medicare Part D plan that covers all of your medications. Medicaid and "Extra Help" recipients both receive a continuous Special Enrollment Period and ca . . .






Advertisement

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

Advertisement

Browse 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
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
$250 Doughnut Hole Rebate (Only in 2010)


Pets are Family Too!
Use your drug discount card to save on medications for the entire family ‐ including your pets.

  • No enrollment fee and no limits on usage
  • Everyone in your household can use the same card, including your pets
Your drug discount card is available to you at no cost.




Advertisement



Ask a Pharmacist*
Have questions about your medication?

» Answers to Your Medication Questions, Free!
Available Monday - Friday
8am to 5pm MST
*A free service included with your no cost drug discount card.



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.