The Low-Income Subsidy (LIS) Program, also known as Extra Help, can lower your monthly premium by helping pay for your Medicare Prescription drug plan costs.
People with Medicare who have incomes up to 150% of the federal poverty line and resources at or below the limits for partial low-income subsidy benefits are eligible for full benefits under the Part D Low-Income Subsidy (LIS) Program.
This law eliminates the partial LIS benefit currently in place for individuals with incomes between 135% and 150% of the poverty line.
Additionally, in accordance with 42 CFR §423.780, all low-income subsidy individuals are entitled to a premium subsidy equal to 100% of the premium subsidy amount.
Low-Income Subsidy (Extra Help) Premiums
This table shows what your monthly plan premium will be depending on your level of extra help. CHPW Medicare Advantage premiums listed are for both medical services and prescription drug benefits.
| Do You Have Extra Help? (LIS) | MA DUAL Complete PLAN (HMO DSNP) | MA DUAL Select PLAN (HMO DSNP) | MA PLAN 2 (HMO) | MA PLAN 3 (HMO) | MA PLAN 4 (HMO) |
|---|---|---|---|---|---|
| Yes | $0.00 | $0.00 | $0.00 | $38.40 | $65.50 |
| No | $40.60 | $40.60 | $38.40 | $79.00 | $105.00 |
Note: The premiums listed above do not include any Medicare Part B premium you may have to pay. LIS does not apply to $0 premium plans such as Plan 1 or plans without a drug benefit such as the Freedom Plan.
Learn More About Extra Help
How to Apply for Extra Help
See if you qualify by contacting:
- Medicare: 1-800-MEDICARE (TTY: 1-877-486-2048), 24 hours a day/7 days a week
- Social Security: 1-800-772-1213 (TTY: 1-800-325-0778), 7:00 a.m. – 7:00 p.m., Monday through Friday
Best Available Evidence Requirement
If you believe you qualify for Low-Income Subsidy (LIS) and are paying the incorrect cost-sharing amount, we can help. Over the phone or at your local clinic, we can:
- Review your eligibility
- Guide you through the process of obtaining evidence of your proper co-payment level
- Help you fill out the necessary forms
Contact us for assistance at 1-800-942-0247 (TTY Relay: 711), 8 a.m. to 8 p.m., seven days a week.
Read our Best Available Evidence Requirement (BAE) policy here. We follow the Centers for Medicare & Medicaid Services (CMS) BAE to determine a member’s Low-Income Subsidy. Acceptable forms of evidence are:
- Your State Medicaid ID Card
- Other evidence from the state showing that you are Medicaid eligible
- SSA letter that shows your Supplemental Security Income (SSI) effective date
- SSA award letter that says you are automatically eligible for Extra Help
To submit BAE documentation, members may:
- Mail to:
Community Health Plan of Washington
Attn: Medicare Advantage
1111 Third Avenue, Suite 400
Seattle, WA 98101 - Fax to 1-206-652-7050
- Call 1-800-942-0247 (TTY Relay: 711) for assistance
As soon as one of the forms of BAE is presented, we will update our system so you can pay the correct copayment when you get your next prescription at the pharmacy.
CHPW Medicare Advantage is an HMO plan with a Medicare contract. Enrollment in CHPW Medicare Advantage depends on contract renewal. The benefit information provided is a brief summary, not a complete description of benefits. For more information, contact us.
Did you know that certain prescription medicines are available as a 90-day supply? Medicine that you take on a long-term basis to manage your health is called a “maintenance drug.” A 90-day supply makes it easier to keep taking the medicine you need to feel your best. You may also be eligible to receive your long-term medications through free home delivery.
