1. Extra Help Low Income Subsidy Help with Prescription Drug Costs
Updated February 2017

2. agenda Overview Qualifications What Counts Be Prepared Ways to Apply
Overview
Qualifications
What Counts
Be Prepared
Ways to Apply
Application & Determination
Questions

3. About me - - - - - - - - - - - - - - - - - -
Independent Broker – Not a carrier rep or government employee.
Professional - Licensed & certified every year to understand Medicare.
Trained hours obtaining certifications from top Medicare carriers every year.
24/7 - I am available to help throughout the year, not just during Annual Enrollment.
Explain who you are and what you can do for them
You don’t work for Medicare or Social Security

4. Overview - - - - - - - - - - - - - - - - - - -
Low Income Subsidy (LIS) or Extra Help
A prescription assistance program available to Medicare beneficiaries with limited resources & income. Administered by Social Security it provides assistance with Medicare prescription drug plans:
Premiums.
Annual Deductibles.
Prescription Copayments/Coinsurances.
The Extra Help is estimated to be worth about $4,000 per year.
In 2017, drug costs for most people who qualify are no more than:
$3.30 for each generic covered drug.
$8.25 for each brand-name covered drug.
Other people pay only a portion of their Medicare drug plan premiums and deductibles based on their income level. 
(In 2016, costs are no more than $2.95 for each generic/$7.40 for each brand-name covered drug.)

5. Example Prescription* MAPD Plan Copay with Full LIS
Example of the LIS Difference:
Formulary Tier*
Example Prescription*
Example
MAPD Plan Copay*
MAPD Plan Copay with Full LIS
Tier 1
Metformin Hcl $4
$3.30
Tier 2
Diltiazem Hcl $8
Tier 3
Novolog FlexPen
$45
$8.25
Tier 4
Exforge
$95
Monthly Total:
$152
$23.10 MAX
*Actual prescription tier levels & plan copays will vary from plan to plan
Sources:
- February 2017
- February 2017

6. Qualifications
Social Security will need to know the value of your savings, investments, real estate (other than your home), & your income. They need information about you & your spouse, if you are married & living together.
To qualify for LIS or Extra Help you must be:
Receiving Medicare
Have limited resources & income
Reside in one of the 50 States or the District of Columbia.
2017 Income & Resource Limitations
Income
Resources
Individuals - $13,820*
Individuals - $12,320**
Married & Living Together -$27,600*
Married & Living Together -$24,600**
* Income amounts reflect threshold without/with the $20 monthly income disregard (annually = $240); income is rounded to the nearest whole dollar.
** Asset limits include amount with $1,500/person burial allowance.
***If your annual income is higher, you still may be able to get some help. A few examples are: You support other family members who live with you, have earnings from work, or live in Alaska or Hawaii.

7. What counts - - - - - - - - - - - - - - - - - - - - - - - - -
*Countable Resources Include:
Stocks & Bonds
Mutual Funds & IRA’s
Money in a checking, savings, or CD accounts
*Countable Resources Do Not Include:
One car
Furniture
Burial plot
Your home
Other household & personal items
Up to $1,500 for burial expenses if you have put that
money aside
Some People Automatically Qualify for Extra Help if They:
Have full Medicaid (Medi-cal) coverage
Get help paying your Part B premiums (in a Medicare Savings Program) 
Get Supplemental Security Income (SSI) benefits 
*Not A Comprehensive List, Consult for Complete Details*

8. Full Low-Income Subsidy (LIS) Extra Help (2017) - 48 STATES + DC ***
Updated 2/14/2017
Beneficiary Group
Annual Income Eligibility Requirement*
Monthly Income Eligibility Requirement*
Asset Eligibility Requirement**
Need to Apply for LIS?
Monthly
Premium
Annual
Deductible
Copay/Coinsurance Plan’s Formulary Drugs
Full-Benefits Duals: Institutionalized or Receiving Home & Community-based Services
Meet State Medicaid financial eligibility
No, receive it automatically No
None
Full-Benefit Duals: income
< 100% FPL
Meet State Medicaid/MSP financial eligibility
Copay:
$1.20 Generic, $3.70 Brand
Catastrophic Copay: $0
Full-Benefit Duals: income > 100% FPL
$3.30 Generic, $8.25 Brand Catastrophic Copay - $0
Non-duals: income < 135% FPL AND lower asset levels
Single: $16,281*
Couple: $21,924*
Single: $1,357*
Couple: $1,827*
Single: $7,390
Couple: $11,090
No, if receiving SSI; otherwise, Yes
Partial Low-Income Subsidy (LIS) Extra Help (2017) - 48 STATES + DC ***
Beneficiary Group
Annual Income Eligibility Requirement*
Monthly Income Eligibility Requirement*
Asset Eligibility Requirement**
Need to Apply for LIS?
Monthly
Premium
Annual
Deductible
Copay/Coinsurance Plan’s Formulary Drugs
Non duals with income < 135% FPL AND assets between lower & higher limits
Single: $16,281*
Couple: $21,924*
Single: $1,357*
Couple: $1,827*
Single: Between $7,390 - $12,320
Couple: Between $13,931 - $27,250
Yes No
$82
Coinsurance:15% Catastrophic Copay: $3.30 Generic, $8.25 Brand
Non duals with income
between % FPL
Single: $18,090*
Couple: $24,360*
Single: $1,508*
Couple: $2,030*
Single: $11,090
Couple: $24,600
Yes,
Sliding
Scale
2017 LIS breakdown of all levels and copays
Blue is Full LIS, Red is Partial LIS
Don’t read all of this information to them
* Income limits do not include the $20 income disregard and monthly income, 135% FPL and 150% FPL are rounded to nearest whole dollar.
** All asset limits are without $1,500 per person burial allowance.
***Alaska & Hawaii Not Shown
Income & Asset Source - Feb 2017

9. Be Prepared - - - - - - - - - - - - - - - - - - - - - - - - -
What You Need to Apply:
Most of the questions on the application are about resources & income. If you are married & living with your spouse, they will need to know information about both of you.
A Few Key Things to Have Ready or Know:
All Resource & Income Information you can gather
Financial statements, investment statements, stock certificates, tax returns, etc.
Identify the things you own alone, with your spouse, or with someone else
Do not include your home, vehicles, burial plots, life insurance policies, or personal possessions
Social Security won’t ask for proof to support the information you provide, but they will match your information with data available from other government agencies to make sure it is correct.
Need Help?
Family members, caregivers and other third parties can help you complete the application.

10. Ways to apply - - - - - - - - - - - - - - - - - - - - - - - - - - -
Applying for Extra Help is quick & easy!
4 Ways to Apply:
Apply online at
Call Social Security at (TTY ) to apply over the phone.
3) Call Social Security & request an application be mailed to you.
Apply at your local Social Security office.
After you apply, Social Security will review your application & send a letter letting you know if you qualify. If you qualify, you can choose a Medicare prescription drug plan or it will apply to your existing plan.
If you don’t select a Prescription Drug Plan, the Centers for Medicare & Medicaid Services will do it for you.

11. Special Election Period
Apply online at:
SEP can take effect 1st of the month following approval for Soc Sec.
Medicare’s LIS
Special Election Period

12. Application - - - - - - - - - - - - - - - - - - - - - - - -
The application itself is relatively short & straight forward.
Here are a Few Sample Questions:
Are you assisting someone (other than your spouse who lives with you) with this application?
Do you (or your spouse, if married and living together) have Medicare? 
Are you (or your spouse, if married and living together) 64 years and 9 months old or older?
Have you (or your spouse, if married & living together) received Social Security disability benefits for 24 months; disability benefits based on Lou Gehrig's disease (ALS); or Renal dialysis treatments or a kidney transplant? 
In which State do you (and your spouse, if married and living together) live? 
Do you have combined savings, investments and real estate worth more than $27,600 if you are married and living with your spouse; or $13,820 if you are not married or not living with your spouse? 
If your spouse has Medicare (or expects to have it in the next three months), does he or she also wish to apply?
This is more than 50% of the questions they will be asked
Mostly Yes and No questions
Don’t read all of these when presenting

13. Determination
A determination letter will be sent out after you apply for Extra Help.
Be Patient - It can take up to 45 days to arrive from Social Security.
What if I’m Approved?
You will receive an award letter stating your eligibility and assistance will begin the 1st of the following month. The Extra Help can be applied to your current Prescription Drug Plan or allow you a Special Election Period to change to a more appropriate plan.
What if I’m Denied?
Social Security will send you a pre-decisional notice if the information in our records shows you are ineligible for Extra Help. If you disagree with the information they have, call or visit a Social Security office within 10 days of receiving the pre-decisional notice to provide corrected info.
A final determination will follow soon after provided you don’t need to correct any information.
Can I appeal the final determination?
Yes, if you want to appeal the determination Social Security made about your eligibility for Extra Help you can do so online, over the phone, or in person with Social Security within 60 days of receiving your determination.
Still need more information?
You can visit call MEDICARE,
OR… simply ask your presenter!

14. Questions???