“Extra Help” 2012 Income and Resource Amounts

The Low Income Subsidy, often abbreviated as “LIS,” and often called “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 and 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 or are in a community-based waiver program:

You pay nothing.

Your income is at or below $11,170 (individual) or $15,130 (couple):

You pay $1.10 for a generic or preferred brand, and $3.30 for a non-preferred brand.*


Your income is above $11,170 (individual) or $15,130 (couple)

You pay $2.60 for a generic or preferred brand, and $6.50 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 $2.60 for a generic or preferred brand, and $6.50 for a non-preferred brand.*


If you are not as above, but qualify for Extra Help because your income and resources levels are as below, the cost of your drugs will be as follows, and you will be subject to an annual deductible and premium payments as follows:

If your income is below $15,080 (individual) or $20,426 (couple) & resources are at or below $8,440 (individual) & $13,410 (couple):

You pay $2.60 for a generic or preferred brand, and $6.50 for a non-preferred brand.* You pay neither a premium nor a deductible.


If your income is below $15,080 (individual) or $20,426 (couple) & resources are at or below $13,070 (individual) & $26,120 (couple):

You pay 15% of the cost of your drugs, plus you are subject to a $65 annual deductible.** You pay no premium.


If your income is at or below $15,638 (individual) or $21,182 (couple) & resources are at or below $13,070 (individual) & $26,120 (couple):

You pay 15% of the cost of your drugs, plus you are subject to a $65 annual deductible, and you must pay 25% of your premium.**


If your income is below $16,197 (individual) or $21,939 (couple) & resources are at or below $13,070 (individual) & $26,120 (couple):

You pay 15% of the cost of your drugs, plus you are subject to a $65 annual deductible, and you must pay 50% of your premium.**


If your income is below $16,755 (individual) or $22,695 (couple) & resources are at or below $13,070 (individual) & $26,120 (couple):

You pay 15% of the cost of your drugs, plus you are subject to a $65 annual deductible, and you must pay 75% of your premium.**


*If your “drug expenses” ever exceed $4,700 in 2012, you will pay nothing for any prescription.

**If your “drug expenses” in the year ever exceed $4,700 in 2012, you will pay not more than $2.60 for a generic or preferred brand, and $6.50 for a non-preferred brand.


Note on resource limits: Technically, the resource limits are $6,940 for an individual and for $10,410 a couple for “Full Subsidy” beneficiaries, and $11,570 for an individual and $23,120 for a couple for “Partial Subsidy” beneficiaries. However, in practice, when determining resources for Extra Help, the Social Security Administration allows an extra burial expense allowance of $1,500 for an individual or $3,000 for a couple, so these resource limits are almost always shown as $8,440 for an individual and $13,410  for a couple for “Full Subsidy” beneficiaries, and $13,070 for an individual and $26,120 for a couple for “Partial Subsidy” beneficiaries, and these are the limits shown above.


Key Words: Part D Medicare Prescription Drug Benefit Low Income Subsidy Extra Help 2011 Federal Poverty Levels

Originally Posted 02-19-12