Low Income Subsidy

Beneficiaries of Medicare on low-income subsidy (LIS) are assisted with payments for their Part D monthly premium, coinsurance, deductible, and copayment. Also, for people enrolled in the Extra Help program, there is no gap existing in their prescription drug coverage—which is also called Medicare “donut hole.”

Medicare Extra Help Eligibility

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People with limited income yet eligible for benefits may qualify for LIS, which helps in paying for Medicare Part D prescription drug costs. Beneficiaries of Medicare on low-income subsidy (LIS) are assisted with payments for their Part D monthly premium, coinsurance, deductible, and copayment. Also, for people enrolled in the Extra Help program, there is no gap existing in their prescription drug coverage—which is also called Medicare “donut hole.” The individual’s income when compared to the Federal Poverty Level and resource limitation dictates the amount of subsidy.
You may be eligible for low-income subsidy under the Medicare part D if:

Annual Income

Your annual income including your asset is not up to the eligibility thresholds. The limit for Medicare Extra Help program may vary from one year to another. Your annual income is more than the eligibility thresholds. However, you’ll provide support for other members of your family living under your roof.

Accounts

Cash and bank accounts, as well as savings, checking, and certificates of deposit

Primary Residence

Real estate not within your primary residence.

Stocks & Bonds

Stocks and bonds, including U.S. savings bonds

Fund

Mutual funds and IRAs

In calculating eligibility for the low-income subsidy, Medicare will not include resources like your home, car or insurance policies. A lot of people are eligible for Medicare Extra Help savings without their knowledge. If you want to know whether you qualify, apply!

How to apply for Medicare Extra Help

If you want to apply for the Medicare low-income subsidy, you’re required to fill out an Application for Extra Help with Medicare Prescription Drug Plan Cost form with Social Security. The application and submission can be achieved:

  • When you apply online at www.socialsecurity.gov/extrahelp.
  • When you call Social Security at 1-800-771-1213 (TTY 1-800-325-0778) and request that the application is mailed to you, or apply over the phone. The representatives of Social Security are always available via phone, Monday to Friday—7AM to 7 pm.
  • When you apply at your local Social Security office—in person.
  • When Social Security has reviewed it, and you receive a notification in your mail that you’re eligible. If that is the case and you’re not enrolled in Medicare Part D Prescription Drug Plan, you may enroll in a plan at that time.

Medicare Savings Program

With Medicare Savings Programs, low-income earners can pay out-of-pocket costs for Medicare, as well as Medicare Part A and Part B premiums, copayment, deductibles, and coinsurance. Because an individual is eligible for some Medicare Savings Programs, they automatically qualify for Extra Help program too—and provide help for beneficiaries to pay for prescription drugs.

Four types of Medicare Savings Programs exist:

  • Qualified Medicare Beneficiary (QMB
  • Qualifying Individual (QI) Program
  • Specified Low-Income Medicare Beneficiary (SLMB)
  • Qualified Disabled and Working Individuals (QDWI) Program

Medicare Savings Programs

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With Medicare Savings Programs, low-income earners can pay out-of-pocket costs for Medicare, as well as Medicare Part A and Part B premiums, copayment, deductibles, and coinsurance. Because an individual is eligible for some Medicare Savings Programs, they automatically qualify for Extra Help program too—and provide help for beneficiaries to pay for prescription drugs.

Four types of Medicare Savings Programs exist:

  • Qualified Medicare Beneficiary (QMB)
  • Qualifying Individual (QI) Program
  • Specified Low-Income Medicare Beneficiary (SLMB)
  • Qualified Disabled and Working Individuals (QDWI) Program

They all have unique benefits and support payment of Medicare Part B premium except QDWI.

To be considered, you must be eligible for Medicare Part A, and your income must be lower than a particular threshold. For each of the four Medicare Savings Programs, the income and resource requirements differ and may change over the years.

The following resources will be vital to determine eligibility:

  • Checking accounts
  • Savings accounts
  • Bonds
  • Mutual funds
  • Stocks
  • Individual Retirement Accounts (IRAs)

The following resources are irrelevant to determine eligibility:

  • Your home
  • Burial plot
  • Burial expenses (Up to $1,500, as long as you have the money)
  • One car
  • Furniture
  • Personal items
  • Household items

Income and asset calculation may be done differently. What that means is that even if income and resources are higher than the listed limit, you may still be eligible. Get in touch with your State Health Insurance Assistance Program to know if you’re eligible or not.

QMB Program

Qualified Medicare Beneficiary Program

It assists in paying for Medicare Part A (hospital insurance) premium and also Medicare Part B (medical insurance) premium. It might interest you to note that the program also takes care of Medicare cost-sharing expenses and deductibles as well as coinsurance and copayments.

If you’re eligible for QMB, you’re immediately considered for Extra Help prescription drug program so you can save on out-of-pocket expenses as regards medications. You must have been enrolled in Medicare Part A for you to apply for QMB Medicare Savings Program.

SLMB Program

Specified Low-Income Medicare Beneficiary Program

If earnings are a little above the maximum QMB income criteria, you may qualify for SLMB program. It takes care of Medicare Part B premiums. It will not pay other cost-sharing expenses or even Medicare Part A premiums. However, you can have a higher income. Similar to QMB, if you’re eligible for SLMB Program, you’re immediately considered for the Extra Help Prescription drug program too.

You’ll have to meet income and asset requirements to qualify. Criteria for eligibility vary from one year to another.

QI Program

Qualifying Individual Program

This is yet another level of the Medicare Saving Programs. Even if you’re not eligible for QMB or SLMB, you can still apply for QI Medicare Savings program. This program is responsible for the Medicare Part B premium payment, and the individual will automatically qualify for Extra Help prescription drug program. Take note, reapplication will be carried out yearly for these benefits. Benefits are given out on first-come, first served basis because of the limited funds available. Individual who had QI benefit the previous year will be given attention.

QDWI Program

Qualified Disabled and Working Individuals Program

This program is not the same as the other three Medicare Savings Programs. QDWI will pay for Medicare Part A premiums. You will be considered eligible for this program if :

  • You lost premium-free Medicare Part A after returning to work.
  • You’re under 65 and disabled, and working at the moment.
  • You are not receiving state medical assistance.
  • You fulfill the income and resource criteria for your state.

You can contact Medicare for more information to know if you’re eligible.

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