Low Income Subsidy or “Extra Help”

Medicare beneficiaries who have limited income and resources may qualify for extra help to pay for prescription drugs costs. This low-income subsidy ( LIS ) from Medicare provides financial assistance for beneficiaries who have limited income and resources. Those who are eligible for this low-income subsidy will get help paying for their monthly premium, yearly deductible, prescription coinsurance and copayments and no gap in coverage.

Some people are automatically eligible for the low-income subsidy ( LIS ) . Those include people who are receiving: both Medicare and Medicaid; SSI with Medicare; benefits Medicare Savings Programs.

Who Should Complete This Application For Extra Help With Medicare Prescription Drug Plan Costs?

Generally, if your monthly income is at or below these levels... You may be eligible for...
$1471 (individual)
$1991 (couple)
LIS Extra Help - offers assistance with Medicare Part D (prescription drug plan) only
$1313 (individual)
$1770 (couple)
QI - offers payment of Medicare Part B premium only
$1167 (individual)
$1573 (couple)
SLMB - offer payment of Medicare Part B premium only
$981 (individual)
$1328 (couple)
QMB - offers payment of Part B premium and Medicare deductibles and co-insurance up to the approved Medicare rate

EXCEPTION: Even if you meet these conditions, DO NOT complete this application if you have Medicare and Supplemental Security Income (SSI) or Medicare and Medicaid because you automatically will get the extra help.

Dual Eligible Programs (Sometimes Called Medicare Savings Programs)

The state has programs that are part of the Medicaid program (sometimes called Medical Assistance) that will pay some of the costs of Medicare. The programs have similar names but offer different benefits. They also have slightly different qualifications. Your client’s income and resources (if any) determine which program they can apply for.

These programs are called:

Qualified Medicare Beneficiary (QMB)
Specified Low-Income Medicare Beneficiary (SLMB)


Qualified Medicare Beneficiary (QMB) Program

Your Client May be Eligible for the Qualified Medicare Beneficiary (QMB) Program If:

  • He/she is entitled to Medicare Part A (also known as hospital insurance).
  • If they do not have Medicare Part A because they cannot afford it, the QMB program may pay the Medicare Part A premium for them.
  • He/she has an income of 100 percent of the Federal Poverty Level or less and resources not exceeding twice the limit for SSI eligibility.

What expenses does the QMB program cover?

  • Medicare Part A deductible
  • Medicare Part B (also known as medical insurance) premium
  • Medicare Part B deductible
  • Co-insurance (co-insurance is typically 20% of approved Part B costs not paid to doctors by Medicare—this is normally the individual’s out-of-pocket expense)
  • Co-insurance for extended hospital stays and skilled nursing (this is normally an out-of-pocket expense)
  • In some cases, the Medicare Part A premium
  • The cost of additional health services and prescriptions if your client qualifies for full Medicaid services as well (QMB Plus)

Specified Low-Income Medicare Beneficiary (SLMB) Program

Your Client May be Eligible for the Specified Low-Income Medicare Beneficiary (SLMB) Program If:

  • He/she is entitled to Medicare Part A.
  • He/she has an income above 100 of the Federal Poverty Level, but less than 120 percent of the Federal Poverty Level and resources not exceeding twice the limit for SSI eligibility

What expenses does it cover?

  • Medicare Part B premium
  • The cost of additional health services and prescriptions if they qualify for full Medicaid services (SLMB Plus).