Medicare has announced the Low Income Subsidy (LIS) resource limits for 2021. Also called Extra Help, this program provides financial assistance with Medicare prescription drug costs.
The Social Security Administration says that the Extra Help is worth approximately $5,000 per year. Qualifying for Extra Help can make a huge difference for your clients, so the new LIS resource limits are important.
Applying for Extra Help
Some Medicare beneficiaries automatically qualify for Extra Help, but others have to submit an application.
According to CMS, Medicare beneficiaries automatically qualify if they have full Medicaid coverage, get help paying for Medicare Part B from their state’s Medicaid program or get Supplemental Security Income benefits.
However, people who do not qualify automatically may still be eligible. Additionally, people who don’t qualify for the full LIS amount may still qualify for partial assistance. Medicare beneficiaries can apply for Extra Help through the Social Security Administration.
Qualifying for Extra Help
To qualify for Extra Help, an individual must be enrolled in Medicare Part A and/or Part B and live in one of the 50 states or the District of Columbia. Additionally, they must meet the resource limits, and these limits may be adjusted annually.
For 2021, the resource limits for full LIS help are $7,970 if single and $11,960 if married, and the resource limits for partial LIS help are $13,290 if single and $26,520 if married.
If beneficiaries plan to use some of their resources to cover burial expenses, they can notify the Social Security Administration of this, and their resource limits will be adjusted. For 2021, the resource limits for people who have set aside funds for burial expenses are $9,470 if single and $14,960 if married for full assistance, and $14,790 if single and $29,520 if married for partial assistance.
When counting resources, applicants should include real estate other than the primary residence, bank accounts, stocks, bonds, mutual funds, IRAs and cash. Applicants should not include their primary residence, personal possessions, vehicles, life insurance policies and certain other excluded items. See the Social Security Administration’s guide for details.
Receiving Extra Help
Medicare beneficiaries who are approved for Extra Help should make sure their Medicare prescription drug plan knows that they qualify. They should also make sure that they are not charged more than is allowed.
For Medicare beneficiaries receiving Extra Help in 2021, the maximum copay for generic prescriptions is $3.70 and the maximum copay for covered brand-name prescriptions is $9.20.
For more information, you can open the CMS Memo, in PDF format here.