2011 Income Amounts for the Part D Prescription Drug Low Income Subsidy or “Extra Help”

The federal government recently released the federal poverty income levels (FPLs) for 2011, and they have increased slightly over 2010 levels, which will probably enable some beneficiaries to qualify for “Extra Help,“ particularly because Social Security payments did not automatically increase for 2011. The Low Income Subsidy or Extra Help allows Medicare beneficiaries with low incomes and resources who enroll in Part D to qualify for full or partial payment of their premiums, deductibles and reduces their co-payments on drugs. Full payment of the premium is restricted to plan premiums which are at or below the “benchmark” premium for your state.) This is fully explained in Chapter 7 (which begins on page 99) of Managing Your Medicare. (Finally, these income amounts apply to the contiguous 48 states and the District of Columbia, the income levels (but not the resources levels) are higher for Alaska and Hawaii.)


Those who qualify for Extra Help at these levels will pay no premium, and will not be subject to the deductible, and the cost of their drugs will be as follows:

If you have Medicaid AND:

You live in a nursing home:
You pay nothing.

Your income is at or below $10,890 (individual) or $14,710 (couple):
You pay $1.10 for a generic or preferred brand, and $3.30 for a non- preferred brand.*

Your income is above $10,890 (individual) or $14,710 (couple)
You pay $2.50 for a generic or preferred brand, and $6.30 for a non- preferred brand.*


You don't have Medicaid but your state helps you pay your Medicare premiums (that is, you are in the “Medicare Savings Program”) OR you get supplemental security income (SSI):
You pay $2.50 for a generic or preferred brand, and $6.30 for a non- preferred brand.*


You are not as above but qualify for Extra Help because of your income and resources levels as follows:

If your income is below $14,702 (individual) or $19,859 (couple) & resources are at or below $8,180 (individual) & $13,020 (couple):
You pay $2.50 for a generic or preferred brand, and $6.30 for a non- preferred brand.*

If your income is below $14,702 (individual) or $19,859 (couple) & resources are
at or below $12,640 (individual) & $25,260 (couple):
You pay 15% of the cost of your drugs, plus you are subject to a $63 annual deductible.**

If your income is at or below $15,246 (individual) or $20,594 (couple) & resources are at or below $12,640 (individual) & $25,260 (couple):
You pay 15% of the cost of your drugs, plus you are subject to a $63 annual deductible, and you must pay 25% of your premium.**

If your income is below $15,791 (individual) or $21,330 (couple) & resources are at or below $12,640 (individual) & $25,260 (couple):
You pay 15% of the cost of your drugs, plus you are subject to a $63 annual deductible, and you must pay 50% of your premium.**

If your income is below $16,335 (individual) or $22,065 (couple) & resources are at or below $12,640 (individual) & $25,260 (couple):
You pay 15% of the cost of your drugs, plus you are subject to a $63 annual deductible, and you must pay 75% of your premium.**


*If your “drug expenses” ever exceed $4,550 in 2011, you will pay nothing for any prescription.

**If your “drug expenses” in the year ever exceed $4,550 in 2011, you will pay not more than $2.50 for a generic or preferred brand, and $6.30 for a non-preferred brand.