Part D costs can add up quickly. Not only do you have to pay monthly premiums, you will pay an annual deductible and a coinsurance or copay for any medications you receive. Depending on what medical conditions you have and what medications you take, you may need Extra Help paying for your medications.

What Is the Part D Low Income Subsidy (LIS)?

Also known as Extra Help, the Part D Low Income Subsidy (LIS) is a federal subsidy program that helps to pay down part or all of your Part D expenses. The program looks at your current income and assets to decide if you need assistance. The Social Security Administration estimates it saves beneficiaries an average of $5,300 every year!

Anyone who qualifies for both Medicare and Medicaid is automatically eligible for the subsidy, and they will receive full benefits. Likewise, anyone on one of the Medicare Savings Programs — specifically the Qualified Medicare Beneficiary (QMB), Specified Low-Income Medicare Beneficiary (SLMB), or Qualified Individual (QI) Programs — gets automatic enrollment with full benefits. Finally, anyone actively receiving SSI benefits with an income less than 135% of the federal poverty limit (FPL) and who meets asset criteria is automatically enrolled for full Extra Help.

All other people will need to see if they qualify and apply to participate in the program. They may receive either full or partial benefits depending on their income and assets. Please note that the information in the following tables represents the income and asset limits for most states. The established limits may be higher in Alaska and Hawaii.

2023 Extra Help with Full Benefits

Only the most financially in need qualify to get the full benefit. With no premiums or deductibles to pay, your benefits start with your very first prescription. How much you pay is based on whether you are prescribed a generic or brand-name medication.

Eligibility Group	What You Will Pay	Income Limits*	Asset Limits
People eligible for Medicaid – AND – Live in an institutional facility or receive home health services	Part D premium: $0 Part D deductible: $0 Copay (generic): $0 Copay (brand): $0	Based on state Medicaid eligibility requirements	Based on state Medicaid eligibility requirements
People eligible for Medicaid – AND – Income level </= 100% FPL	Part D premium: $0 Part D deductible: $0 Copay (generic): $1.45 Copay (brand): $4.30	Based on state Medicaid eligibility requirements	Based on state Medicaid eligibility requirements
People eligible for Medicaid – AND – Income level > 100% FPL	Part D premium: $0 Part D deductible: $0 Copay (generic): $4.15 Copay (brand): $10.35	Based on state Medicaid eligibility requirements	Based on state Medicaid eligibility requirements
Income </= 135% FPL – AND – Low assets	Part D premium: $0 Part D deductible: $0 Copay (generic): $4.15 Copay (brand): $10.35	Single: $1,660 per month $19,920 per year      Married: $2,239 per month $26,868 per year	Single: $9,090      Married: $13,630

2023 Extra Help with Partial Benefits

Unlike the full benefit program, some people who receive partial benefits may need to pay a portion of their Part D premiums. They all have to pay a $104 deductible though. That said, the deductible is significantly lower than the maximum deductible set by the federal government each year ($505 in 2023). At first, the drug discount is lower than what you would receive with the full benefit program. Once you reach the level for catastrophic drug coverage ($7,400 in true out of pocket costs in 2023), you will receive the full benefit rate for each drug you take.

Eligibility Group	What You Will Pay	Income Limits*	Asset Limits
Income </= 135% FPL – AND – Medium assets	Part D premium: $0 Part D deductible: $104 Coinsurance: 15% Copay (catastrophic – generic): $4.15 Copay (catastrophic – brand): $10.35	Single: $1,660 per month $19,920 per year      Married: $2,239 per month $26,868 per year	Single: $9,090 – $15,160      Married: $13,630 – $30,240
Income 135 – 150% FPL	Part D premium: Sliding scale Part D deductible: $104 Coinsurance: 15% Copay (catastrophic -generic): $4.15 Copay (catastrophic – brand): $10.35	Single: $1,843 per month $22,116 per year      Married: $2,485 per month $29,820 per year	Single: $15,160      Married: $30,240

Good News: People who qualify for partial Extra Help benefits in 2023 will qualify for full benefits in 2024. That’s because the Inflation Reduction Act, passed in 2022, will allow people to qualify for full benefits if they are at or below the 150% federal poverty limit.

An Added Bonus

If you had Part D late penalties before you became eligible for Extra Help, they get wiped out when your Extra Help benefits start. That’s right. They go away forever, saving you even more.

 

2023 Federal Poverty Level Guidelines (FPL): 2023/2024 LIS Qualifications and Benefits. (2023). Q1medicare.com. https://q1medicare.com/news/Article.php?article_id=395&utm_source=partd&utm_medium=textlink&utm_campaign=SSA-LIS-Section

2023 Resource and Cost-Sharing Limits for Low-Income Subsidy (LIS). (2022). Centers for Medicare & Medicaid Services. https://www.cms.gov/files/document/lis-memo.pdf

Extra Help Program: Income and Asset Limits 2023. Medicare Rights Center. (2023). https://www.medicarerights.org/fliers/Help-With-Drug-Costs/Extra-Help-Chart.pdf?nrd=1

Extra Help with Medicare Prescription Drug Plan Costs | SSA. (2022). SSA.gov. https://www.ssa.gov/benefits/medicare/prescriptionhelp.html

Help with drug costs | Medicare. (2023). Medicare.gov. https://www.medicare.gov/basics/costs/help/drug-costs

H.R.5376 – 117th Congress (2021-2022): Inflation Reduction Act of 2022. (2022). Congress.gov. https://www.congress.gov/bill/117th-congress/house-bill/5376/text

Poverty Guidelines | Office of the Assistant Secretary for Planning and Evaluation. (2023). ASPE. https://aspe.hhs.gov/topics/poverty-economic-mobility/poverty-guidelines

 

Past Year: 2022

Current Year: 2023

Subsequent Years: 2024