Do you need help paying for your prescription medications? Wondering if there are programs out there that can provide relief? You should know about the Medicare Part D Low Income Subsidy (LIS, or “Extra Help”).

What is LIS/Extra Help? It’s a program that covers some of the Part D prescription drug plan costs, including Part D premiums, deductibles, and copayments. The Social Security Administration (SSA) and Centers for Medicare & Medicaid Services (CMS) work together to administer LIS/Extra Help. Its estimated average annual value is $5,900 per person.

What are the benefits of LIS/Extra Help?

This program provides several key benefits:

• Access to prescription drug coverage
• Waiver for Part D late enrollment penalty
• Eligibility for a Special Enrollment Period (SEP) once during each of the first three quarters and again during the annual Medicare Open Enrollment Period (Oct. 15 - Dec. 7). A SEP allows you to enroll in a Part D plan or change your coverage.
• Potential auto-enrollment in Medicare Savings Programs (such as QMB, SLMB, and QI)

LIS/Extra Help eligibility requirements

To be eligible for LIS/Extra Help, you must meet three requirements or one special condition:*

• Have Medicare Part A and/or Part B
• Live within the U.S. (50 states or Washington D.C.)
• Meet additional eligibility criteria
• Receive Medicaid orSupplemental Security Income (SSI), or be enrolled in a Medicare Savings Program (such as QMB, SLMB, and QI)*

What does LIS/Extra Help cover?

In 2024, the LIS Partial Subsidy was eliminated, and eligibility for the Full Subsidy was expanded to people with incomes up to 150% of the Federal Poverty Level (FPL).

With the Full Subsidy, both the deductible and plan premium for Part D are waived. In 2024, you will pay no more than $11.20 for each brand-name drug the plan covers ($4.50 for generic). Once your total out-of-pocket drug costs reach the catastrophic threshold ($8,000 in 2024), you will have no copays.

Enrolling in LIS/Extra Help

If you’re enrolled in both Medicare and Medicaid, you receive Supplemental Security Income (SSI), or you qualify for one of the Medicare Savings Programs, you’ll be enrolled in LIS/Extra Help automatically and receive a letter from CMS confirming your enrollment.

If you do not qualify for automatic enrollment, you’ll need to apply for Extra Help through the Social Security Administration (SSA). Applications can be submitted both online or via a paper application you can pick up at your local SSA office. You can find a link to submit an Extra Help application to SSA at NCOA's BenefitsCheckUp.org.

A decision letter will be mailed to you upon determination of eligibility, usually within three weeks of submitting your completed application. Once you’re found eligible, you’ll receive Extra Help for at least the remainder of the year.

Temporary drug coverage through LINET

If you qualify for Extra Help or Medicaid, and you have no prescription drug coverage, you may be eligible for the Limited Income Newly Eligible Transition (LINET) Program. LINET provides immediate but temporary Medicare Part D coverage for low-income Medicare enrollees. This benefit is available for up to two months until you enroll in a Part D plan that meets your needs. Learn more about LINET.

“Prescription drug coverage is a key component of Medicare and a vital part of aging well,” said Jen Teague, Director for Health Coverage and Benefits at NCOA. “It’s important that all older adults are aware of Extra Help as well as other benefits programs that can help them save money and stay healthy and independent for as long as possible."