How Does A Consumer Who Qualifies For Low Income Subsidy Receive Financial Assistance For Their Part Of Medicare Part D Costs? (2023)

FAQs

How does lis work in a medicare advantage plan? ›

The Low-Income Subsidy (LIS) program 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.

The Low-Income Subsidy (LIS) is a Medicare program to help people with limited income and resources pay Medicare prescription drug program costs, like premiums, deductibles, and coinsurance. The Low-Income Subsidy (LIS) is also known as Extra Help.

The direct subsidy is the plan's bid, adjusted by the Part D risk model, minus the beneficiary's premium. The reinsurance payment covers the expected spending for the government's share of costs for claims in the catastrophic phase of the benefit.

You can get a stand-alone Part D plan (also known as a PDP plan). Or, you can opt to get a Medicare Advantage plan that includes drug coverage.

Medicare Advantage, also called Part C, is an option within Medicare that allows Medicare- eligible seniors and beneficiaries with disabilities to receive their benefits through a private plan of their choice, instead of receiving coverage through Traditional Fee-For-Service (FFS) Medicare.

This page contains information on eligibility for the Low-Income Subsidy (also called "Extra Help") available under the Medicare Part D prescription drug program.

Low income consumers include individuals whose financial resources or income are inadequate to provide a "socially acceptable" standard of living.

These guidelines are adjusted each year for inflation. In 2023, the federal poverty level definition of low income for a single-person household is $14,580 annually. Each additional person in the household adds $5,140 to the total. For example, the poverty guideline is $30,000 per year for a family of four.

For 2023, Medicare's actuaries estimate that Part D plans will receive direct subsidy payments averaging $106 per enrollee overall, $2,855 for enrollees receiving the LIS, and $1,140 in reinsurance payments for very high-cost enrollees; employers are expected to receive, on average, $557 for retirees in employer- ...

What will the Medicare donut hole be in 2023? ›

You enter the donut hole when your total drug costs—including what you and your plan have paid for your drugs—reaches a certain limit. In 2023, that limit is $4,660. While in the coverage gap, you are responsible for a percentage of the cost of your drugs. How does the donut hole work?

In 2023, you'll enter the donut hole when your spending + your plan's spending reaches $4,660. And you leave the donut hole — and enter the catastrophic coverage level – when your spending + manufacturer discounts reach $7,400. Both of these amounts are higher than they were in 2022, and generally increase each year.

Is Medicare Part D worth it? Your health can be unpredictable, so while you may not need many, or any prescription drugs now, you may need them in the future. It's better to enroll in Medicare Part D when you enroll in Original Medicare even if you don't currently need prescription drugs.

Medicare Supplement Plan D

This plan covers everything that Plan C does, except for that Part B deductible. The only difference between Plan D and Plan G is that Part B excess charge coverage. So if you're deciding between the two, your decision will likely depend on how important that excess charge coverage is to you.

The standard monthly premium for Medicare Part B enrollees will be $164.90 for 2023, a decrease of $5.20 from $170.10 in 2022. The annual deductible for all Medicare Part B beneficiaries is $226 in 2023, a decrease of $7 from the annual deductible of $233 in 2022.

Medicare Advantage is a Medicare-approved plan from a private company that offers an alternative to Original Medicare for your health and drug coverage. These “bundled” plans include Part A, Part B, and usually Part D. • In most cases, you can only use doctors who are in the plan's network.

Extra Help is a federal program that helps pay for some to most of the out-of-pocket costs of Medicare prescription drug coverage. It is also known as the Part D Low-Income Subsidy (LIS).

Medicare Advantage and Medicare Supplement are different types of Medicare coverage. You cannot have both at the same time. Medicare Advantage bundles Part A and B often with Part D and other types of coverage. Medicare Supplement is additional coverage you can buy if you have Original Medicare Part A and B.