What if you have Medicare and SSI or you have both Medicare and Medicaid how do you qualify for LIS or Extra Help?
Answered by 12 licensed agents
If you have Medicaid, SSI, or a Medicare Savings Program, you typically qualify automatically for Extra Help (Low-Income Subsidy) with your Medicare Part D drug costs. This means your premiums, deductibles, and copays for prescriptions are significantly reduced. You usually do not need to apply separately because the benefit is assigned automatically through the Social Security Administration. If someone does not automatically qualify, they can apply directly through Social Security based on income and asset limits. Extra Help can substantially lower prescription drug costs for eligible Medicare beneficiaries.
LIS ( low income subsidy) and Extra help are the same thing and, based on income, it allows you to get your medications for less, covers your prescription drug deductibles and gives discounts on the premium for prescription drug coverage.
If you have Medicaid you will also have extra help. If you don’t have Medicaid you can apply for extra help. Again extra help is based on income amounts.
If you have SSI, then automatically you qualify for LIS or extra help and Medicaid.
Low income subsidy(LIS) or extra help has income and asset limitation to be qualified for and there is another problem called Medecare saving program. It’s a federal program manage by the state..
If you have both Medicare and Medicaid, then you are already have a higher form of LIS or extra help. Meaning since you have Medicaid, then your part B premium is already paid for and your drugs. Co-pays are significantly less expensive.
SSI is a needs-based program that is administered by the Social Security Administration, and while SSI and Medicare and not directly correlated, many people on SSI are also on Medicaid through their state. Those on Medicare will receive additional assistance if also enrolled in their state's Medicaid program. This can come in the form of Part B premium assistance, prescription drug copay assistance, and other supplementary assistance. It all depends on the level of Medicaid you receive. Also, if you are on Medicaid and 65 or over, there are private plans through Medicare called D-SNPs (Dual Special Needs Plans) that combine the benefits of both Medicare and Medicaid into one plan.
If you have Medicare and SSI you need to apply for Extra Help. Typically, you will receive a paper application in the mail that comes from Social Security. I’ve see this form included in client’s mail when they first sign up for Medicare.
If you have both Medicare and Medicaid, qualifying for LIS or Extra Help should be automatic based on your income. Your Medicaid eligibility would likely qualify you for LIS/Extra Help.
Typically, you will be automatically recognized by the system according to your income level, and the system will automatically implement it. However, if for some reason you are not automatically enrolled, we can help with that process.
LIS or Extra Help is a division of Medicaid. Your enrollment into the program is based on your income and your application to Medicaid.
Medicaid becomes a complex creature after your enrollment into Medicare. Before Medicare, you either have medicaid or you do not.
After Medicare, there are levels of Medicaid, for example LIS, Extra Help, ect. These levels are typically based on your income. For additional resources on Medicaid, I recommend you reaching out to your local SHIIP office if you do not want to visit with me :). SHIIP is the Senior Health Insurance Information Program and is a non-biased counseling service that specializes in assiting in enrollment into programs such as this.
First you look st your monthly income then your liquid assets ie cash available. If you fall in required guidelines, then move forward with an application. The application Is completed through Social Security.
Qualification for LIS or Extra Help typically depends on your income and assets. There are certain thresholds, depending on your specific household, that must be met in order to qualify. Contact your local Medicare agent for assistance or the Medicaid office nearest you for additional information.
You don't have to apply for Low Income Subsidy or Extra Help to pay for your Part D benefits, because you automatically receive it once you are deemed eligible.
