Medicare Part D is a separate prescription drug plan available to Medicare enrollees. This benefit is sold through private, Medicare-approved plans that may stand on their own or come as part of a Medicare Advantage plan.
Like original Medicare, Part D comes with certain out-of-pocket costs in the form of premiums, deductibles, and coinsurance. But what about the people who cannot afford these costs? That’s where the Medicare Part D Low Income Subsidy—often referred to as LIS or “Extra Help”—plays a valuable role. This program, administered by the Social Security Administration (SSA) in collaboration with Medicare, helps people with limited income and resources pay for their prescriptions. SSA estimates that Extra Help has an average annual value of $5,300.
What are the benefits of Extra Help?
Extra Help is available to people with income up to 150% of the Federal Poverty Guidelines/Levels (FPL). In 2024, most people who qualify for Extra Help will pay:
- No premiums for their drug plan
- No deductibles
- No more than $11.20 in 2024 for each brand-name drug the plan covers ($4.50 for generic)
What are the income and asset eligibility guidelines for Extra Help?
Income and asset eligibility thresholds are based on the Federal Poverty Guidelines, which are updated at the beginning of each year by the Department of Health and Human Services (HHS). Income eligibility for Extra Help is the same throughout the U.S., with slightly higher levels for Alaska and Hawaii. People who receive Medicaid, are enrolled in a Medicare Savings Program (MSP), or receive Supplemental Security Income (SSI) will be automatically enrolled into Extra Help.
Temporary drug coverage for people who qualify for Extra Help
The Limited Income Newly Eligible Transition (LINET) program provides immediate but temporary Medicare Part D prescription coverage for low-income enrollees who qualify for Extra Help or Medicaid and have no prescription drug coverage. This benefit is available for up to two months until a person enrolls in a Medicare drug plan. The LINET program is administered exclusively by Humana.
You can find tools and resources to help older adults enroll in LINET on the Humana website.
See what the income and asset eligibility thresholds are for Part D LIS/Extra Help in 2024 in the chart below. This chart also includes what Medicare enrollees with LIS/Extra Help will pay for their prescriptions at the pharmacy in 2024.
Contact us if you would like to obtain a Word version of this chart for use/adaptation in training.
