2021 2022 LIS Table
Level | Subsidy % | Deductible | Generic/Preferred Drugs | Other Drugs | Above Catastrophic Limit |
Level 1 | 100% | $0 | $3. |
95** | $9. |
85** | $0.00 | ||
Level 2 | 100% | $0 | $1. |
35** | $4.00** | $0.00 | |||
Level 3 | 100% | $0 | $0.00 | $0.00 | $0.00 |
Level 4 | 25% |
$92
Up to $99 | 15% Coinsurance |
15% |
Coinsurance |
$3. |
95 Generics $9.85 Brand | |
Level 4 | 50% |
$92
Up to $99 | 15% Coinsurance |
15% |
Coinsurance | $3. |
95 Generics $9.85 Brand | |
Level 4 | 75% |
$92
Up to $99 | 15% Coinsurance |
15% |
Coinsurance | $3. |
95 Generics $9.85 Brand | |
Level 4 | 100% |
$92
Up to $99 | 15% Coinsurance |
15% |
Coinsurance | $3. |
95 Generics $9.85 Brand |
Notes
Copayments for a 30-day supply is the same for a 90-day supply.
IMPORTANT: Medicare Beneficiaries can have LIS without Medicaid. They can have Medicaid without LIS. They are totally separate programs. Medicaid is state program. LIS is Federal program.
Level
There are four levels of Low Income Subsidy.
The “Level”
is the cost responsibility of their medications and deductiblesindicates the beneficiary’s Out of Pocket responsibilities for covered prescriptions.
IMPORTANT NOTE: LIS does not pay the full cost of the drug. Beneficiaries MUST have creditable prescription drug coverage that covers their medicines (PDP/MAPD) and then LIS helps pay the co-pays for the beneficiary. If their drugs are not covered by a PDP/MAPD plan then Extra Help does not help with those drugs.
Subsidy
The Subsidy percentage is the amount paid toward their PRESCRIPTION DRUG premium. LIS/Extra Help DOES NOT pay any part of the Part B premium.
Levels 1-3 subsidize the premium amount 100% of the standard part D premium.
Level 4 subsidizes the premium amount at various rates as indicated in the table.
Deductible
Levels 1-3 have a $0 deductible.
Level 4 has a
$92$99 deductible (the customer will pay the lesser of the Low Income Subsidy amount or the plan’s deductible.)
Additional Information
Income Limits to qualify for LIS in 2022
$1,292.50/month for Individual
$2,579.16/month for married couple living together
How to get LIS/Extra Help
Apply online at www.Socialsecurity.gov/prescriptionhelp
Call the Social Security Administration at 800-772-1213
7AM-7PM Monday through Friday
Anything else?
YES! There’s MORE! Medicare WAIVES any Part D Late Enrollment Penalty for anyone that is deemed eligible for LIS/Extra Help, regardless of level.