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:

• Monthly Premium
  

• Yearly Deductible

• Prescription copayments and/or coinsurance charges (a beneficiary will only have to pay $2.60 for a generic and $6.50 for a brand)  

• 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:

• full benefit dual eligibles (beneficiaries with both Medicare and Medicaid)

• SSI recipients with Medicare

• 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.

Low income subsidy

If you qualify for extra help with your Medicare prescription drug plan costs, your premium and costs at the pharmacy will be lower. When you join one of a  plan, Medicare will tell us how much extra help you are getting.  There are 5 levels of LIS, they are as follows:

0%, 25%, 50%, 75%, 100%

How to inquire about Low Income Subsidy
If you are not getting this extra help, you can see if you qualify by calling Social Security at 1-800-772-1213 (TTY users should call 1-800-325-0778) or visit www.socialsecurity.gov on the Web.

You may also go to the Connecticut Department of Social Services for more information.  For a printable version of the Medicare Savings Program Application/Redetermination form click here.

For the Medicare Savings Brochure click here.

For the Medicare Savings application click here.