Can I get help with my Part D Plan?
Medicare Extra Help
Yes, there are both State and Federal programs available to qualified Medicare Beneficiaries with low incomes to help pay both the premiums of their PDP and cost for their prescriptions.
The Federal program is known as Medicare Low Income Subsidy (LIS) or “Medicare Extra Help”. LIS provides assistance in paying for:
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Monthly Premium (up to $34.57 for 2010)
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Yearly Deductible
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Prescription copayments and/or coinsurance charges (a beneficiary will only have to pay $2.50 for a generic and $6.30 for a brand)
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LIS will also cover prescriptions while a beneficiary is in the Coverage gap.
It is important to note, Medicare Extra Help will only cover a prescription that is listed on the PDP’s formulary and covered by the PDP first. So, LIS will NOT cover a medication that is not the PDP’s formulary or denied by the PDP because of certain coverage limitations and/or prior authorization requirements.
Medicare beneficiaries who qualify for the programs listed below are automatically eligible for LIS. They are:
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full benefit dual eligibles (beneficiaries with both Medicare and Medicaid)
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SSI recipients with Medicare
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Medicare Savings Program (QMB, SLMB and ALMB)
Beneficiaries in these programs will be required to enroll in an approved PDP or “Benchmark” plan to received premium assistance.
To qualify for LIS a Medicare beneficiary’s yearly income (for 2010) must be below $16,245 for a single person or $21,855 for couples and resources (for 2010) less than $12,510 for single and $25,010 for couples. The resource level includes a $1,500 per person burial allowance.
Click here to see the state of CT assistance program