2016 Low-Income Subsidy

Many people who qualify for a Low-Income Subsidy (LIS) for prescription drug coverage (also called “Extra Help”) may not even know it. People with limited income and resources who qualify for this extra financial assistance will receive help paying the monthly premium, yearly deductibles, and drug co-pays for Medicare Part D. Rules for the LIS have recently changed, so even if you applied and were turned down in the past, you may be eligible now.

The amount of extra help qualifying people get is based on income and resources. The LIS program could pay up to 75 percent or more of your drug costs including prescription drug premiums, annual deductibles, co-pays and co-insurance. 

To find out if you qualify, fill out the Low-Income Subsidy Application.

Keep in mind that this low-income subsidy is just for Medicare Part D. You will still need to pay any Medicare Part B premium or Part B late-enrollment penalty you may owe.

If you qualify for a LIS, here is what your savings will look like if you are signed up for coverage under one of FamilyCare’s four Medicare Advantage plans with Part D coverage.

2016 FamilyCare Advantage LIS Premiums 

Your Level of Extra Help Monthly Premium for Community (HMO DSNP)* Monthly Premium for Advantage Rx (HMO)* Monthly Premium for Select Rx (HMO)* Monthly Premium for Choice Rx (PPO)*
100% $0 $0 $128.70 $54.30
75% $0 $0 $130.50 $56.00
50% $0 $0 $132.30 $57.60
25% $0 $0 $134.20 $59.30

(To print a copy of this chart, click here.)

Decisions about LIS eligibility and LIS levels are made by Medicare. If you believe your LIS has been reduced or ended because of a mistake, it may be because Medicare has incorrect or out-of-date information. You may be able to correct the information that Medicare has by submitting up-to-date Best Available Evidence (BAE). To learn more, refer to Medicare’s LIS Best Available Evidence policy.

If you aren’t getting extra help, you can see if you qualify by calling:

  • 800-Medicare (800-633-4227) (TTY 877-486-2048) 24 hours a day, 7 days a week, or
  • The Oregon Health Plan (Medicaid) at 800-273-0057 toll-free (TTY 711) between 8 a.m. and 5 p.m., Monday through Friday, or
  • The Social Security Administration at 800-772-1213. TTY users should call 1-800-325-0778 between 7 a.m. and 7 p.m., Monday through Friday.

You can also contact FamilyCare Navigation Services for more details at 503-345-5702 or toll-free 866-798-2273. From October 1 through February 14, you can reach us seven days a week from 8 a.m. to 8 p.m. (except Thanksgiving and Christmas).* From February 15 to September 30, you can reach us Monday through Friday from 8 a.m. to 8 p.m. and on weekends from 9 a.m. to 5 p.m. (except Memorial Day, Independence Day, and Labor Day).*

*On these holidays, you may leave a voice message and we will get back to you within one business day.

 

FamilyCare Health Plans, Inc., is an HMO and PPO plan with contracts with Medicare and the Oregon Health Plan (Medicaid). Enrollment in FamilyCare Health depends on contract renewal. This information is not a complete description of benefits. Contact the plan for more information. Limitations, co-payments, and restrictions may apply. Benefits, premiums, and or/or co-payments/co-insurance may change on January 1 of each year. You must continue to pay your Medicare Part B premium.

To qualify for Community (HMO SNP), you must be eligible for Medicare Parts A and B and the Oregon Health Plan (Medicaid). If you qualify for Community (HMO SNP), the Oregon Health Plan will pay your Medicare Part B premium for you. Premiums, co-pays, co-insurance, and deductibles may vary based on the level of Extra Help you receive. Please contact the plan for further details.

Updated 10/1/2015

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