Many Medicare beneficiaries qualify for important prescription drug savings but don’t know it. To find out if you might qualify, review the two government programs below that provide financial help related to medications: Low-Income Subsidy (also called Extra Help) and State Pharmaceutical Assistance Programs.
Low-Income Subsidy (LIS), also known as Extra Help, is a program available in all 50 states and Washington, D.C., that lowers monthly premiums, annual deductibles and prescription drug copayments incurred in every level of Medicare prescription drug coverage (Part D and Medicare Advantage with prescription coverage).
To be eligible for Extra Help you must meet both income and resource/asset requirements (see examples of income and resources here). For 2018 you must:
1. Have income at or below:
- If single: $18,450.
- If married: $24,930.
Includes unexpected income that Medicare will ignore (“income disregard”) of $240 annually.
2. Have assets at or below:
- If single: $14,100.
- If married: $28,150.
Includes a $1,500 per person burial allowance.
These limits are higher in Alaska and Hawaii. See the full list of 2018 eligibility requirements and benefits here.
If you are eligible for Medicaid or certain Medicare Savings Programs (QMB, SLMB, QI), you are considered automatically eligible for Extra Help and you do not have to apply. If you are not already eligible for one of these programs you must apply for Extra Help through one of the following methods.
- Online: Visit ssa.gov/i1020/start.
- By phone: Call Social Security at 1-800-772-1213.
- By mail: Request a paper application by calling Social Security at 1-800-772-1213.
- In-person: Schedule an appointment with your local Social Security office.
State Pharmaceutical Assistance Programs (SPAP)
State Pharmaceutical Assistance Programs are offered in many states to help residents pay for prescription drugs. Each SPAP is structured differently and some states even have multiple programs.
Benefits of SPAP vary by state and may include lower monthly premiums, annual deductibles and prescription drug copayments. Many states restrict their SPAP program to Medicare beneficiaries only, but not all.
When applying for SPAP you will need to contact your states’ program for application details.
To find out if SPAP is available in your state and if you qualify search here. Once you have located the SPAP in your state, visit their website for more details and updates on the program.
For more help, read “Ways to Find Financial Assistance.”