Financial Assistance for Medicare Beneficiaries

Medicare Savings Program (MSP) and Low-Income Subsidy (LIS)

The Medicare Savings Program (MSP) and the Low-Income Subsidy (LIS) which is also known as “Extra Help” for drug cost Program,  are federal programs that provide financial assistance to Medicare beneficiaries who have limited income and resources. Both programs help reduce healthcare costs, provide peace of mind, and improve affordability for necessary medical treatments and medications.

If you believe you might be eligible for either of these program, you should apply and see if you can take advantage of the benefits that these programs have to offer.

Eligibility Requirements for Medicare Savings Program (MSP) and Low-Income Subsidy (LIS)

To qualify for either for MSP or for LIS, you must meet certain income and resource limits. Resources count towards this limit include savings, stocks, and bonds. Some resources such as your primary residence, car, and personal belongings, do not count.

For MSP In 2023, the income limit is $1,774 per month for individuals and $2,391 per month for married couples living together. Some states have higher income limits. The resource limit in 2023 is $7,970 for individuals and $11,960 for married couples living together.

To qualify for LIS in 2023, the income limit is $25,155 for individuals and $34,020 for married couples living together. If your income exceeds these limits, you may still be eligible if you have significant out-of-pocket medical expenses. The 2023 resource limits are $10,590 ($16,630 if married) for the full low-income subsidy and $16,660 ($33,240 if married) for the partial low-income subsidy which includes the $1500 per person for burial expenses. You must be enrolled in a Medicare Part D prescription drug plan to receive Extra Help.

The following information and tables are from https://secure.ssa.gov/poms.nsf/lnx/0603001020

2023 FPL table

  1. a.

    48 States and the District of Columbia48 States and the District of Columbia

    Family Size

    100%

    135%

    140%

    145%

    150%

    1

    $14,580.00

    $19,683.00

    $20,412.00

    $21,141.00

    $21,870.00

    2

    $19,720.00

    $26,622.00

    $27,608.00

    $28,594.00

    $29,580.00

    3

    $24,860.00

    $33,561.00

    $34,804.00

    $36,047.00

    $37,290.00

    4

    $30,000.00

    $40,500.00

    $42,000.00

    $43,500.00

    $45,000.00

    5

    $35,140.00

    $47,439.00

    $49,196.00

    $50,953.00

    $52,710.00

    6

    $40,280.00

    $54,378.00

    $56,392.00

    $58,406.00

    $60,420.00

    7

    $45,420.00

    $61,317.00

    $63,588.00

    $65,859.00

    $68,130.00

    8

    $50,560.00

    $68,256.00

    $70,784.00

    $73,312.00

    $75,840.00

    9

    $55,700.00

    $75,195.00

    $77,980.00

    $80,765.00

    $83,550.00

    10

    $60,840.00

    $82,134.00

    $85,176.00

    $88,218.00

    $91,260.00

    Additional

    $5,140.00

    $6,939.00

    $7,196.00

    $7,453.00

    $7,710.00

  2. b.

    Alaska

    Family Size

    100%

    135%

    140%

    145%

    150%

    1

    $18,210.00

    $24,583.50

    $25,494.00

    $26,404.50

    $27,315.00

    2

    $24,640.00

    $33,264.00

    $34,496.00

    $35,728.00

    $36,960.00

    3

    $31,070.00

    $41,944.50

    $43,498.00

    $45,051.50

    $46,605.00

    4

    $37,500.00

    $50,625.00

    $52,500.00

    $54,375.00

    $56,250.00

    5

    $43,930.00

    $59,305.50

    $61,502.00

    $63,698.50

    $65,895.00

    6

    $50,360.00

    $67,986.00

    $70,504.00

    $73,022.00

    $75,540.00

    7

    $56,790.00

    $76,666.50

    $79,506.00

    $82,345.50

    $85,185.00

    8

    $63,220.00

    $85,347.00

    $88,508.00

    $91,669.00

    $94,830.00

    9

    $69,650.00

    $94,027.50

    $97,510.00

    $100,992.50

    $104,475.00

    10

    $76,080.00

    $102.708.00

    $106,512.00

    $110,316.00

    $114,120.00

    Additional

    $6,430.00

    $8,680.50

    $9002.00

    $9,323.50

    $9,645.00

  3. c.

    Hawaii

    Family Size

    100%

    135%

    140%

    145%

    150%

    1

    $16,770.00

    $22,639.50

    $23,478.00

    $24,316.50

    $25,155.00

    2

    $22,680.00

    $30,618.00

    $31,752.00

    $32,886.00

    $34,020.00

    3

    $28,590.00

    $38,596.50

    $40,026.00

    $41,455.50

    $42,885.00

    4

    $34,500.00

    $46,575.00

    $48,300.00

    $50,025.00

    $51,750.00

    5

    $40,410.00

    $54,553.50

    $56,574.00

    $58,594.50

    $60,615.00

    6

    $46,320.00

    $62,532.00

    $64,848.00

    $67,164.00

    $69,480.00

    7

    $52,230.00

    $70,510.50

    $73,122.00

    $75,733.50

    $78,345.00

    8

    $58,140.00

    $78,489.00

    $81,396.00

    $84,303.00

    $87,210.00

    9

    $64,050.00

    $86,467.50

    $89,670.00

    $92,872.50

    $96,075.00

    10

    $69,960.00

    $94,446.00

    $97,944.00

    $101,442.00

    $104,940.00

    Additional

    $5,910.00

    $7,978.50

    $8,274.00

    $8,569.50

    $8,865.00

 

FPL percentage and the amount of Extra Help (premium subsidy)

We determine the amount of a beneficiary’s Extra Help with Part D, also known as the premium subsidy, by the relationship of his or her income (and that of his or her living-with spouse) to the appropriate FPL. For instance, if an individual or couple has income less than 135% of the FPL (and resources are below the specified limit for an individual or couple), they may be eligible for 100% premium subsidy.

The percent of subsidy assistance depends on the level of income, as shown in the following chart.

Countable Income is:

Premium

Subsidy

Up to 135% of FPL

100%

More than 135% FPL, but not more than 140%

75%

More than 140% FPL, but not more than 145%

50%

More than 145% FPL, but less than 150%

25%

150% FPL or more

None

NOTE: We limit low-income premium subsidies to the greater of the lowest plan premium or the CMS-set “benchmark” amount in the person’s area. Therefore, a person with income below 135% of the FPL may still be responsible for paying a portion of the plan’s premium if he or she enrolls in a plan whose premium exceeds the area benchmark. Refer all questions regarding premiums to the PDP or MA-PD provider.

How the Medicare Savings Program Works

MSP may pay for your Medicare Part A premium, which is the part of Medicare that covers hospital stays. MSP may also help pay for Medicare Part B premiums, which cover doctors’ services and outpatient care, and for Medicare Part D deductibles and co-payments.

MSP provides assistance with Medicare premiums, deductibles, and co-payments. Here is how the program works:

  1. Medicare Part A Premium: MSP may pay for your Medicare Part A premium, which is the part of Medicare that covers hospital insurance.
  2. Medicare Part B Premium: MSP may also pay for your Medicare Part B premium, which is the part of Medicare that covers doctor visits and outpatient services.
  3. Medicare Part A and B Deductibles and Co-payments: MSP may also pay for your Medicare Part A and Part B deductibles and co-payments.

There are three levels of MSP, and the level of assistance you receive depends on your income and resources:

  1. Qualified Medicare Beneficiary (QMB): This level provides the highest level of assistance, and it covers Medicare premiums, deductibles, and co-payments for both Medicare Part A and Part B.
  2. Specified Low-Income Medicare Beneficiary (SLMB): This level provides assistance with Medicare Part B premiums.
  3. Qualified Individual (QI): This level provides assistance with Medicare Part B premiums, but the funding is limited, and assistance is provided on a first-come, first-served basis.

How the Low-Income Subsidy (LIS) Program Works

LIS, on the other hand, provides assistance with premiums, deductibles, and co-payments for Medicare Part D prescription drug coverage. Here is how the program works:

  1. Premiums: Extra Help may pay part or all of your monthly Medicare Part D premium.
  2. Deductibles: Extra Help may reduce or eliminate your Medicare Part D deductible.
  3. Co-payments: Extra Help may reduce your out-of-pocket costs for prescription drugs. If you qualify for full Extra Help, you will pay no more than $4.15 for each generic drug and $10.35 for each brand-name drug for 2023.

Additionally, if you qualify for Extra Help, you will not be subject to the coverage gap (also known as the “donut hole”) that applies to Medicare Part D prescription drug coverage.

The Application Process

You can apply for both MSP and LIS at the same time by completing a single application online at https://www.ssa.gov/medicare/part-d-extra-help. You can also visit your local Medicaid office to apply for MSP or your local Social Security office or by calling Social Security at 1-800-772-1213 (TTY 1-800-325-0778) to apply for LIS. When you apply for LIS, your application can be forwarded to your state’s Medicaid office so they can see if you qualify for MSP.

You will need to provide documentation to support your application, such as tax returns, bank statements, and proof of medical expenses when applying. You will receive a letter from the Medicaid office confirming your eligibility for MSP and the level of assistance you will receive. You will receive a letter from Social Security confirming your eligibility for LIS and the level of assistance you will receive.