Beneficiaries with limited income and resources should be encouraged to apply for the low income subsidy (LIS) – also called extra help – through the State Medicaid office or the Social Security Administration (SSA). Beneficiaries may apply at any time.
Visit www.benefitscheckup.org to find benefit programs that can help you pay for medications, health care, food, utilities and more.
Tell beneficiaries to call 1-800-MEDICARE (1-800-633-4227) and say “Medicaid” for the State Medicaid office phone number. If beneficiaries apply to the State Medicaid office for Part D help, the State Medicaid office also will check for eligibility for other low-income assistance programs.
Or call SSA at 1-800-772-1213 or apply online at: www.socialsecurity.gov/prescriptionhelp to apply for help with Part D costs.
After SSA or the State approves an application for extra help, it is effective the first day of the month in which the individual applied.
Other Helpful Information
Some pharmaceutical manufacturers operate programs directly or indirectly that assist low income individuals in obtaining drugs at reduced or no costs.
Some states have assistance programs designed specifically for their residents.
Some programs are “qualified” State Pharmaceutical Assistance Programs or SPAPs that count towards TrOOP and some do not count towards TrOOP.
Becoming familiar with your state’s programs may help a beneficiary address cost-sharing for prescriptions, particularly in the coverage gap.
Most people become eligible for Medicare at age 65. In 2022, the Part B monthly premium for most people is $170.10. Some high-income individuals pay more than the standard premium. Your Medicare Part B premium also can be higher if you do not enroll when you are first eligible, also known as your initial enrollment period. There also is a Medicare Part B deductible of $233.00 in 2022.
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