Understanding Medicare Part D – Prescriptions Drug Plans
Laying a Solid Foundation | Lesson 6

Medicare Extra Help & State Pharmaceutical Assistance Programs

What can you do if your clients can’t afford the costs associated with their prescription drug coverage?

Thankfully, there are programs available from the government to help!

Beneficiaries may be eligible for the Medicare Extra Help program.

It’s a joint effort between CMS and the Social Security Administration to provide financial assistance to those who need help paying for their Medicare prescription drug coverage and prescription drugs.

The program is also known as the Medicare Low-Income Subsidy program, or LIS for short.

Enrollees in this program usually do not have to pay premiums or deductibles for their prescription drug coverage, the Part D late enrollment penalty, full copays or coinsurance, or more than a low set amount that CMS regulates each year.

Not only could your client potentially save $5,000 over the course of a year, but qualifying for Extra Help can also present a sales opportunity for you.

Members of the program qualify for a quarterly Special Enrollment Period to join or switch Part D plans.

They can make a change one time during each of the first three quarters of the year.

There is no SEP for the fourth quarter of the year, since that timeframe coincides with the Annual Enrollment Period.

To verify a client’s Medicare Extra Help Status, you’ll use one of four different methods.

First, you can use an LIS look-up tool in a carrier’s portal, if the carrier has one.

Second, you can call the carrier to ask and confirm your client’s low-income subsidy eligibility.

Third, you can call 1-800-Medicare to confirm a client is eligible for an LIS.

Fourth and finally, you can have your client use their account to check if they qualify for the low-income subsidy.

Right beneath this video, we’ve got a link to a chart that can help you identify your client’s eligibility for LIS status.

It’s this year’s Extra Help Program Income and Asset Limits in an easy-to-read format.

You can either bookmark that resource, print out a copy of the PDF, or both!

Last on our list of Part D cost solutions, State Pharmaceutical Assistance Programs, or SPAPs for short.

These programs are another option for helping your clients lower the cost for their prescription drugs.

An SPAP is a state-operated program that offers prescription drug assistance to residents with low incomes.

It’s funded and run by individual states, so depending on where your client lives, the program will vary by name, eligibility, and coverage help provided.

We’ve also got another resource link for SPAPs, a list organized by state, the name of the program, links to their websites, eligibility requirements, and the contact phone number.

For this one, we recommend bookmarking it and saving a copy on your devices so you can take advantage of the clickable links when you need them.

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