How To Qualify For Low Income Subsidy In Medicare Program In Idaho

Low-Income Subsidy for Medicare Prescription Drug Coverage

The Low Income Subsidy (LIS), also known as "Extra Help," is a program offered by the Social Security Administration (SSA) that helps Medicare beneficiaries with limited income and resources pay for their prescription drug costs. This subsidy can cover some or all of the monthly premiums, deductibles, and coinsurance for Medicare Part D prescription drug plans. Eligibility for the LIS is based on income and asset limits and is determined by the SSA. The program is designed to help seniors who might otherwise struggle to afford the medications they need to manage their health conditions. By reducing out-of-pocket costs for prescription drugs, the LIS can help seniors stay healthier and improve their quality of life.

Chris Antrim Medicare Broker and his office can help you with the application and enrollment into this program. Call our office today with any questions or a review of your current Medicare Advantage or Medigap "supplement" policy.

The amount of this subsidy depends upon your household's size and income level.

You can find out if you qualify by calling 1-800-MEDICARE or visiting medicare.gov/medicaid. If you are eligible to receive the subsidy, it will be added directly to your premium payment at no cost to you.

How To Apply In Idaho

Apply for Extra Help Appeal a decision once you receive Extra Help Medicare Savings Programs (MSP) Related Information Medicare beneficiaries can qualify for Extra Help paying for their monthly premiums, annual deductibles, and co-payments related to Medicare Part D (prescription drug coverage).

We estimate the Extra Help is worth about $5,000 per year. To qualify for Extra Help, you must be receiving Medicare, have limited resources and income, and reside in one of the 50 States or the District of Columbia.

Qualifying for the LIS program in Idaho

To qualify for the Low Income Subsidy program in Idaho, you must meet certain income and resource limits. The income and resource limits for 2023 are as follows:

• For an individual: income must be below $20,880 and resources must be below $14,610.
• For a married couple: income must be below $28,080 and resources must be below $29,160.

Income includes money received from Social Security, pensions, and wages. Resources include cash, bank accounts, stocks, and bonds. Your home, car, and personal belongings are not counted as resources.

If you are not already enrolled in a Medicare Advantage plan through your employer, we encourage you to apply online at www.medicareadvantage.gov/apply/. If you do enroll with an insurance company that offers Extra Help, you will need to contact them directly to find out how they handle appeals.

You may also call 1-800-MEDICARE 24 hours a day 7 days a week to speak with someone who can help you determine whether you qualify for Extra Help.

Other Ways To Apply

You can also call Social Security at 1-800-772-1213 (TTY 1-800-325-0778) to apply over the phone, request a paper application, or schedule an appointment to apply at your local Social Security office For help completing your application, see Instructions for Completing the Application for Extra Help with Medicare Prescription Drug Plan Costs (SSA-1020-INST). The instructions are only guidelines and not to be used as applications.

Once You Receive Extra Help

If you receive Extra Help, we will send you information on how to use it. We may ask that you provide us with additional documentation such as:

• Your most recent tax return;
• Proof of financial hardship;
• Documentation showing why you cannot afford to pay all of your medical bills;
• Evidence that you live alone or share expenses with another person who has no other source of income;
• Other documents needed by our staff to determine eligibility.

Medicare Savings Programs (MSP) In Boise

In addition to Extra Help, there are other ways that people who receive Supplemental Security Income, Temporary Assistance for Needy Families, Medicaid, Veterans Administration Medical Benefits, Indian Health Service, Department of Defense Dependents' Education Fund, and/or State Children's Health Insurance Program may get extra money from us to pay for health care costs. These programs are called Medicare Savings Programs.

Who might need help with their LIS?

There are 4 groups of people who already have the LIS but may need some help to keep it or to understand that their LIS is changing. We send them targeted notices on colored paper when there are changes to their LIS.

1. People who won't automatically be eligible for the LIS Each September, we mail a notice (CMS Publication No. 11198) (PDF) on gray paper to people who'll no longer automatically get the LIS. This notice is a LIS application, and it includes a postage-paid pre-addressed envelope. These people may still qualify for the LIS, but they will need to send in a new application. The gray notice:

• Tells the person why they no longer automatically qualify for the LIS
• Encourages them to fill out and send in a LIS application

2. People who'll have a change to their LIS co-payment In early October, we mail a notice (CMS Publication No. 11199) (PDF) on orange paper to people who'll qualify for extra help but will have a chance to their co-payment.

3. People who'll be reassigned to a new plan In early November, we mail notice on blue paper (CMS Publication No. 11208) (PDF) to people who qualify for the LIS but will be reassigned to a new prescription drug plan starting on January 1st.

We automatically reassign people who:

• Qualify for the full (100%) premium subsidy.
• Are in a prescription drug plan that's raising the premium above the low-income premium amount.
• Were enrolled in their current plan by CMS.
• We'll also automatically reassign people who qualify for the LIS if their prescription drug plan leaves the Medicare Program.

4. People who chose their plan In early November, we mail a notice (CMS Publication No. 11267) (PDF). Whose premium cost will increase, but we're not automatically reassigning to a new plan, because they chose and joined their plan.

Who qualifies for the full (100%) premium subsidy, but are in a plan that's increasing their premium amount so it's more than the standard low-income premium subsidy amount. This notice tells people about the increase in their drug plan premium costs and explains their options to stay in their plan or join another plan (including plans they won't pay a monthly premium for).

Medicaid

The federal Medicaid program provides health care for low-income people, including pregnant women and children under age 18 who are blind or have disabilities. It also covers nursing home residents with limited income and their families. The state of Illinois participates in the Medicaid program as well. To apply for benefits, contact your local county office of social services. You can find out more information by calling 1-800-889-4400.

PACE

The PACE Program provides assistance to low-income individuals who are unable to afford the cost of their housing or utility bills. The PACE Program also assists in paying rent if you have been evicted from your home because of nonpayment of rent. You may be eligible for this benefit even if you do not live in an area served by the PACE Program.

Shelter Plus

This program offers emergency shelter services to homeless families and single adults at no charge.

A yellow or green automatic enrollment notice from Medicare An Extra Help "Notice of Award" from Social Security An orange notice from Medicare that says your copayment amount will change next year (medicare.gov)

Documentation of the amount, you paid in premiums and out-of-pocket costs is required. You can get this information from your insurance company or by contacting a state agency that administers Part D programs, such as:

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Our office works with residents all over Idaho. Located in Boise but we are available in person, zoom or over the phone.

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