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The Extra Help/Low-Income Subsidy (LIS) Program

Drug costs under Extra Help

Extra Help ensures you pay the lowest price for prescriptions—and once you hit catastrophic coverage, you should pay nothing. See how it works.

Last Updated: April 2, 2025

In 2025, you will pay

Monthly premium A premium is an individual’s monthly payment to a Medicare or other health insurance plan for coverage.

$0 if you are enrolled in a basic Part D Part D, also known as the Medicare prescription drug benefit, is the part of Medicare that provides prescription drug coverage. Part D is offered through private companies either as a stand-alone plan, for those enrolled in Original Medicare, or as a set of benefits included with a Medicare Advantage Plan.  drug plan with a premium at or below the Extra Help premium limit in your state

Copayments

If you have Extra Help Extra Help, also known as the Part D Low-Income Subsidy (LIS), is a federal program administered by Social Security that helps pay for some to most of the out-of-pocket costs of Medicare prescription drug coverage, including coinsurances, deductibles, and premiums. People with Medicare who have income and assets below specified limits are eligible for Extra Help, which has different levels. Depending on your income and assets, you may qualify for either full Extra Help or partial Extra Help. People may also be automatically enrolled in Extra Help if they have certain other types of coverage, even if their income and assets are above the set levels. and your income is above $1,325

  • $4.90 generic copay  
  • $12.15 brand-name copay  

If you have Medicaid Medicaid is a federal and state program that provides health coverage for certain people with limited income and assets. and your income is below $1,325

  • $1.60 generic copay
  • $4.80 brand-name copay 

$0 when you reach $2,000 in out-of-pocket costs Out-of-pocket costs are health care costs that you must pay because Medicare or other health insurance does not cover them. in lmthteyear.

Get Help Applying for Medicare Cost-Savings Programs

If you live in New York, the Medicare Rights Center can help you enroll in various Medicare cost-savings programs. Please answer a few questions to see if we can connect you with a trained benefits enrollment counselor.

Contact your local State Health Insurance Assistance Program

Each state offers a SHIP, partly funded by the federal government, to give you free counseling and assistance. A SHIP counselor may be available by phone or in person.

Visit www.shiptacenter.org to find your local SHIP office.

Contact your local State Health Insurance Assistance Program

Based on the information you provided, you do not appear to be eligible for Medicare cost-saving programs.

[glossary_exclude]Each state offers a State Health Insurance Assistance Program (SHIP), partly funded by the federal government, to give you free counseling and assistance. A SHIP counselor may be available by phone or in person.[/glossary_exclude]

Visit www.shiptacenter.org to find your local SHIP office.

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If you have Extra Help, throughout the year you will pay either the Extra Help copayment or your plan’s copay for your prescription drugs. You always pay the lower cost between the two. Note that plan copays for prescriptions may change during the year, meaning at times the price for your prescription drugs may differ.

Example: Mr. S has Extra Help and a monthly income above $1,325. His Extra Help copays are $4.90 for generics and $12.15 for brand-name drugs. His plan copay for generics is $1.25, so Mr. S will pay the plan copay of $1.25 because it is cheaper than the Extra Help copay of $4.90.  

Glossary Terms

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