LIS – Low Income Subsidy 2022 Chart – Extra Help
Get help paying for your prescriptions
Low Income Subsidy – Extra Help
The Low-Income Subsidy (LIS) program/extra helps pay for a portion of Part D prescription drug plan costs, including Part D premiums, deductibles and copayments.
Depending on your income and assets, you may qualify for the full subsidy or a partial subsidy. All beneficiaries who qualify for the LIS program are permitted to change Part D plans once a month at anytime during the year. CA Health Care Advocates The full Low-Income Subsidy (LIS) program covers the premium and deductible of benchmark plans, that meet the minimum standards. This means you do not pay a premium or deductible if you receive the full LIS benefit and enroll in a benchmark plan. You are, however, still responsible for copayments of $3.70 to $9.20 for each covered prescription. CA Health Care Advocates
SSA.Gov LIS/Extra Help
What help can I receive?
The Social Security Extra Help is estimated to be worth about $5,000 per year. To qualify for the Extra Help, a person must be receiving Medicare, have limited resources and income (scroll down to view) and reside in one of the 50 States or the District of Columbia.
Medicare beneficiaries can qualify for Extra Help with their Medicare prescription drug plan costs. The Extra Help is estimated to be worth about $4,000 per year. To qualify for the Extra Help, a person must be receiving Medicare, have limited resources and income, and reside in one of the 50 States or the District of Columbia.
I feel that the brochure on Medicare Rx Coverage, their extra help section really explains it IMHO the best, simplest and easiest way to understand.
- See if you qualify for Extra Help and apply SSA.gov
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Qualifications to get Extra Help
- You have Medicare Part A (Hospital Insurance) and/or Medicare Part B (Medical Insurance); and
- You live in one of the 50 States or the District of Columbia; and
- Your combined savings, investments, and real estate are not worth more than $29,160, if you are married and living with your spouse, or $14,610 if you are not currently married or not living with your spouse.
- (Do NOT count your home, vehicles, personal possessions, life insurance, burial plots, irrevocable burial contracts or back payments from Social Security or SSI.)
- Your annual income must be limited to $19,140 for an individual or $25,860 for a married couple living together. Even if your annual income is higher, you may still be able to get some help.
- Some examples where your income may be higher and you can still get Extra Help include if you or your spouse:
• Support other family members who live with you.
• Have earnings from work.
• Live in Alaska or Hawaii.
- Some examples where your income may be higher and you can still get Extra Help include if you or your spouse:
- EXCEPTION: If you have Medicare and Supplemental Security Income (SSI) or Medicare and Medicaid [Medi-Cal] you automatically will get the extra help. Publication 10525 * Social Security ONLINE Application for Extra Help * Publication 10508 Understand
- Extra Help forms and publications
- Extra Help information for caregivers and organizations
- State Manual 31 page pdf
- Extra Help with Medicare Prescription Drug Plan Costs SSA.gov & Apply
- Understanding Part D #ExtraHelp10508
- Guide to Medicare Rx – Publication 11109 Extra Help Section
Prescription Drug 2022 #RxGuide
PDF # 11109
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Coverage Gap - Donut Hole $2,000 Cap
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- Premiums for those with High Income Parts D Rx & B Doctor Visits
- Medicare Rules for High Income People Medicare Costs # 11579
- Our #High Income Surcharge Video Explanation
- Our webpage on High Income Surcharge IRMAA
- Kaiser Foundation Introduction - Overview
- Medicare Rx Benefit Manual Rev 1.2016 83 pages
- Network Pharmacies, Formularies & Common Coverage Rules # 11136
- Insulin Maximum Co Pay $35
- Graphic on Part D Premium Increases & Why?
- Maximus Appeals LEP Late Enrollment Penalty
- VIDEO How Part D Late Enrollment Penalty is calculated
- Shop & Compare Tools Part D Rx
- Get Instant Quotes, Information & Enroll online
- MANDATED wording!: ‘‘We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1–800–MEDICARE to get information on all of your options.’’ § 422.2267(e)(41).
- We disagree with the above wording, as we can use the same tools on Medicare.gov as they do!
Extra Help with Medicare Prescription Drug Costs
Social Security Handbook
LIS Low Income Subsidy – Extra Help Levels
Income & Assets Charts 2022
- Source CMS LIS Memo 10.25.2021
- See also Your Guide to Medicare Drug Coverage Extra Help Section
#Understanding Medicare Advantage Plans (PDF) #12026
Insurance Companies get a fee from the Federal Government, when you enroll in an MAPD plan. MAPD Plans must cover all A & B services Medicare.Gov *
That's why the premium is very low or ZERO!
- Set a phone or Skype Meeting
- #Intake Form - We can better prepare for the meeting
- HMO - Narrow Networks?
- Do I just sign up with a Medicare Advantage Company and automatically get * Parts A & B or do I have to get those from Medicare.Gov * VIDEO
- Get Quotes, Full Information and Enroll
- MANDATED wording!: Think Advisor * ‘‘We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1–800–MEDICARE to get information on all of your options.’’
- We disagree with the above wording, as we can use the same tools on Medicare.gov as they do!
- FYI a 4.27.2022 HHS Office of the Inspector General report found that MAPD plans denied 13% of prior authorizations that would have been covered under original Medicare (Conversely, Medi Gap, just follows what Medicare pays.)
- 88% of MAPD enrollees are happy
-
MAPD plans often include Dental & Part D - Rx Prescriptions and often have NO premiums! How is that possible? The Federal Government pays them around $700/month to handle your medical care. You must continue to pay your Medicare Part B premium of about $170/month. It's best to apply when you turn 65 for the supplement plans or advantage plans, as that's the main "Open Enrollment" period, guaranteed issue for any plan.
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Medicare Advantage Plans also have an annual open enrollment now known as AEP Annual Election Period October 7 to December 15th.
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Additional Coverage is important as Medical Bills are increasing Seniors Credit Card Debt or leading to possible bankruptcy?
Here’s #MoreAassistance
Even if you have high assets & Income
Beyond Part D Rx
Assistance Programs from the Manufacturer
and Government Programs
This tool includes Merck
CA Health Care Advocates – Resources for Rx Drug Savings
The Patient Access Network (PAN) Foundation is dedicated to helping federally and commercially insured people living with life-threatening, chronic and rare diseases with the out-of-pocket costs for their prescribed medications. Partnering with generous donors, healthcare providers and pharmacies, PAN provides the underinsured population access to the healthcare treatments they need to best manage their conditions and focus on improving their quality of life.
Pharmaceutical Assistance Program
National Patient Advocate Foundation
National Organization for Rare Disorders
California Prescription Drug Discount Program
At Medi-Cal participating pharmacies, you can get prescription drugs at the Medi-Cal rate plus a $0.15 processing fee. This rate may be lower than the Part D rate. Payments may not apply toward your Part D cost-sharing. This program should not be used as a substitute for Medicare Part D. To receive benefits, show your Medicare card at Medi-Cal participating pharmacies SB 393 2000
6 Hints to get help with Rx costs on Medicare.gov
Glaxo Smith Kline Rx Assistance
pfizer rx pathways.com Find Assistance That’s Right for You Pfizer RxPathways connects eligible patients to a range of assistance programs that offer insurance support, co-pay help,* and medicines for free or at a savings.† Enter the name of the medicine you’ve been prescribed. You can search one medicine at a time. Then answer a few questions to see which available program(s) may be right for you.
- The Assistance Fund 877-245-4412
- GoodDays 877-968-7233
- HealthWell Foundation 800-675-8416 *Medicare only
- copaxone.com/shared-solutions
- RxAssist.org RxAssist can help you learn about ways to use pharmaceutical company programs and other resources to help reduce your medication costs. Look at our database and frequently asked questions to get started.
Coupons
If one has Part D Rx, the manufacturers cannot help out with coupons. One might consider dropping Part D or if you have Medicare Advantage Plan, finding one that doesn’t include Part D. We CANNOT advise you to do this. It’s beyond our pay grade and we are mandated to tell you about the penalty if you don’t purchase Part D. Scroll down for hints from one of our wholesalers on using coupons and not using your Part D Rx plan.
The intention for coupons is to steer patients away from cheaper generic alternatives and toward the brands that they produce. Experts estimate that brand drug manufacturers are spending between $3 billion and $6 billion annually on coupon programs. Anti-Kick Back and all. HHS Report Mfg safeguards might not prevent coupons for Part D Rx Legally, the use of drug co-pay cards and coupons by individuals with government funded health care and prescription drug benefits, such as Medicare and Medicaid, is prohibited by the federal anti-kickback statute.
(2) Whoever knowingly and willfully offers or pays any remuneration (including any kickback, bribe, or rebate) directly or indirectly, overtly or covertly, in cash or in kind to any person to induce such person—
(A) to refer an individual to a person for the furnishing or arranging for the furnishing of any item or service for which payment may be made in whole or in part under a Federal health care program, or SSA.gov
Here’s some hints from our wholesaler…
Coupons are allowed to be used in Medicare, but it is tricky. When a client uses a coupon, or a GoodRX or even the pharmacies billing costs (which are sometimes cheaper than the plan copay) the drug doesn’t get run through Medicare, it becomes a cash pay situation and it doesn’t go against the Medicare deductibles, donut hole, etc. So that is the negative.
I have many clients that have purchased drugs directly from the pharmacy to get a lower cost, and some that have used Good RX or even just googled their drugs and bought them online at a cheaper cost.
There are certain things that are much cheaper online, Progesterone is a big one that my female clients find cheaper online..
So, if the pharmacy will work with the client to help them find the lowest cost, there are alternatives for our Medicare clients. Not all pharmacies will do this however, so it is good to do some research on more expensive drugs to find alternative solutions.
#Understanding Medicare Advantage Plans (PDF) #12026
Insurance Companies get a fee from the Federal Government, when you enroll in an MAPD plan. MAPD Plans must cover all A & B services Medicare.Gov *
That's why the premium is very low or ZERO!
- Set a phone or Skype Meeting
- #Intake Form - We can better prepare for the meeting
- HMO - Narrow Networks?
- Do I just sign up with a Medicare Advantage Company and automatically get * Parts A & B or do I have to get those from Medicare.Gov * VIDEO
- Get Quotes, Full Information and Enroll
- MANDATED wording!: Think Advisor * ‘‘We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1–800–MEDICARE to get information on all of your options.’’
- We disagree with the above wording, as we can use the same tools on Medicare.gov as they do!
- FYI a 4.27.2022 HHS Office of the Inspector General report found that MAPD plans denied 13% of prior authorizations that would have been covered under original Medicare (Conversely, Medi Gap, just follows what Medicare pays.)
- 88% of MAPD enrollees are happy
-
MAPD plans often include Dental & Part D - Rx Prescriptions and often have NO premiums! How is that possible? The Federal Government pays them around $700/month to handle your medical care. You must continue to pay your Medicare Part B premium of about $170/month. It's best to apply when you turn 65 for the supplement plans or advantage plans, as that's the main "Open Enrollment" period, guaranteed issue for any plan.
-
Medicare Advantage Plans also have an annual open enrollment now known as AEP Annual Election Period October 7 to December 15th.
-
Additional Coverage is important as Medical Bills are increasing Seniors Credit Card Debt or leading to possible bankruptcy?
#GoodRx
We do not know who they are. We are not endorsing them. We’ve heard from some of our clients, who are happy with them.
On the other hand...
No Coupons allowed for Part D Rx
#Co-Pay Accumulator Programs
If a patient has an insurance plan with an accumulator program, all copays funded by the manufacturer copay savings program will not count towards their deductible and annual maximum out-of-pocket costs. When this patient goes to refill their prescription without the copay savings program, they will be responsible for the full cash price of the drug until they reach their deductible and out-of-pocket annual maximum.
In the absence of accumulator programs, when a patient uses a copay savings program, the portion paid by the manufacturer would contribute to the patient’s deductible. However, copay accumulator programs are designed to keep manufacturer contributions from counting towards a patient’s deductible and annual maximum out-of-pocket costs.
- CMS allows all Insurance Plans to do this. Good Rx.com * Actuary Magazine.org * Policy Med.com * ThomsonReuters *
- Los Angeles Times explanation April 2018
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Court Ruling in favor of Rx companies: The dispute centers on programs in which drug companies help patients cover their share of the prescription drug costs that they otherwise could not afford.
In recent years, some insurers have established so-called accumulator adjustment programs, in which they do not count assistance toward patients’ deductibles and out-of-pocket maximums. Such programs effectively capture some of the assistance for insurers instead of patients. Read More Reuters.com
Response from Anthem Blue Cross CA…
Blue Shield of CA
This confirms member’s who use manufacturer coupons for prescriptions, will be credited the amounts paid towards their deductible/out-of-pocket.
Oscar
At this time, the only amount that will contribute towards the members deductible and/or out of pocket maximums will be the amount that the member pays.
Pamphlets, Brochures & Websites to help prevent Fraud
- #Stop Medicare Fraud Website
Protect yourself from Medicare Fraud Publication # 10111 
- Prevent Fraud Publication # 11491
- Medicare Learning Network Prevent, Detect & Report Fraud & Abuse
- California Department of Insurance on Fraud
-
New MD’s – how to avoid Medicare & Medicaid – Medi Cal Fraud and Abuse
Doctor who performed unneeded procedures guilty in $12-million Medicare fraud scheme Los Angeles Times- CMS will be able to revoke healthcare providers or suppliers’ Medicare enrollment if they are affiliated with targeted “bad actors,” a final rule issued Wednesday established.
- As part of the CMS’ “Program Integrity Enhancements to the Provider Enrollment Process” going into effect Nov. 4, its new “affiliations” provision allows authorities to bar individuals and organizations that “pose an undue risk of fraud, waste or abuse based on their relationships with other sanctioned entities.” Modern Health Care *
YouTube VIDEO's
Have Medi Cal pay Medicare Part B $170 Premium #Costs # 10126
Medi Cal * Part B Outpatient Premium Forgiveness
- Medicare.Gov MSP Medicare Savings Programs
- National Council on Aging MSP
- CA Department of Aging 1-800-434-0222 -
- health care rights.org Serving Los Angeles County
- dpss.lacounty.gov/savings
- Disability Benefits 101
- SSI-Related Medicaid Coverage Groups
- MSP Medicare Savings Plan CA Health Care Advocates
- khn.org/billions-of-dollars-in-benefits-go-unused
#Medicare10050 and You
2023 Everything you want to know
- Steve's Video Seminar Introduction to Medicare & You
- Audio from Medicare.Gov
- Clear View to Medicare Patient Advocate.org - 36 pages
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- Your Medicare #Benefits # 10116
- Don't like computers? Prefer a printed version be mailed to you? Audio MP 3
- Inpatient ONLY - How Medicare Pays for your Surgery Part A vs Part B Very Well Health.com
- medicare.gov/coverage
- Enroll in Blue Cross
- Learn about UHC United Health Care
- Enroll in Blue Shield
- Use our scheduler to Set a phone, Skype or Face to Face meeting
- TITLE XVIII—HEALTH INSURANCE FOR THE AGED - Medicare AND DISABLE
Links & Resources
- My Advocate Helps Save money, engage with your community, and improve your health. Take advantage of the different programs in your area. My advocate makes it easy to find programs that fit your life.
- CA Health Advocates.org on LIS/Extra Help
- Hi Cap Medicare Counseling ca health advocates.org/hicap/
- Federal Poverty Level Chart
- 4 Ways to Help Lower your Medicare Prescription Drug Costs # 11417
- LA Times 8.10.2014 Tips to save $$$
- Jewish Free Loan Assoc.
- The Implications Of Rutledge v. PCMA For State Health Care Cost Regulation
#My Medi-Cal
How to get the Health Care
You Need
24 pages
Smart Phones - try turning sideways to view pdf better
- Medi Cal Explained CHCF
- Our Webpages on
- Medi Cal Benefits
- Denti Cal
- Medi-Cal – MAGI Income Eligibility Criteria
-
BIC Benefits Identification Card
https://www.goodrx.com/insurance/health-insurance/prescription-insurance-vs-medical-insurance
https://www.pharmacy.ca.gov/consumers/medicare_discount.shtml
Good Rx can’t be used if you have a Part D Rx plan???
Good Rx is a front for MAPD marketing?
https://www.needymeds.org/
https://www.modernhealthcare.com/legal/pfizer-copay-program-violates-anti-kickback-law-court-rules
https://healthpayerintelligence.com/news/63-of-medicare-beneficiaries-paid-full-generic-drugs-cost-in-2020