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MMA Frequently Asked Questions:
Extra Assistance for People with Limited Income (The Low-income Subsidy Program)

 

1. What is the Low-income Subsidy?

The Medicare prescription drug benefit includes extra help for people with limited incomes. This assistance helps eligible people with their Medicare prescription drug costs, including premiums, deductibles, and coinsurance costs.


2. Who should apply?

People with Medicare who have limited incomes should apply.  People with Medicare and Medicaid will automatically be eligible and do not need to apply.


3. How do I apply?

People should apply through the Social Security Administration (SSA) using SSA’s scannable application or at SSA’s website www.ssa.gov.  Do not make photocopies of the application.  It will not work.

SSA has sent application packets to more than 260,000 people in Oregon.  If you do not have an application, you can get one from SSA or a local social service office.  Call 1(877) 585-0007 for assistance.


4. How is LIS eligibility determined?

SSA will determine eligibility based on a person’s income, assets and family size.  There are three levels of assistance based a person’s income and assets.


5. How does SSA define income?

Income includes the income of the person applying, their spouse and any other family member living in the household.  Some examples of income that is counted are:
  • Benefits such as social security benefits, railroad retirement;
  • Earnings;
  • Money from investments and pensions; and
  • Rental income.

6. How does SSA define assets?

Assets include:
  • Liquid assets (Those that can be converted to cash within 20 days)
  • Real estate, excluding the applicant’s primary residence;
  • Cash and savings accounts; and
  • Some insurance policies.

7. How does SSA define household size?

SSA defines household to include all family members living in the same house.  Family members include all your relatives related by blood, marriage or adoption who rely on you for at least half of their support.


8. What are the eligibility requirements for each of the three groups?

The first group is for those individuals who receive Medicaid (help through the state) and whose income is at or below 100% of Federal poverty level (FPL).  People in this group:
  • Do not pay a premium or deductible,
  • Do pay $1 for generic drugs and $3 for name brand drugs

Note: People in this group do not need to apply for the assistance.  They are already eligible.

The second group is for people whose income is between 100% and 135% FPL and whose assets are below $6,000 for an individual and $9,000 for a married couple or people with Medicaid with incomes above 100% of FPL.  This group pays:

  • No premium and no deductible,
  • $2 for generic drugs and $5 for name brand drugs.
The third group includes households with incomes below 150% FPL and with assets at or below $10,000 for an individual and $20,000 for a married couple.  This group pays:
  • A sliding scale premium based on income,
  • A $50 annual deductible,
  • 15% of all other drug costs up to $5,100, and
  • $2 for generic drugs and $5 for name brand drugs after reaching the $5,100.

9. When will I know if I qualified for assistance?

SSA will notify individuals as soon as possible. People should apply now so they do not lose benefits in January 2006.