Extra Help Paying for Prescription Medications

Low Income Subsidy (LIS)

What Extra Help is Available?

Medicare provides extra help to pay prescription drug costs for people who have limited income and resources. Resources include your savings and stocks, but not your home or car. If you qualify, you will get help paying for your Medicare drug plan's monthly premium, yearly deductible, and prescription co-payments. If you qualify, this extra help will count toward your out-of-pocket costs.

If you get extra help from Medicare to help pay for your Medicare prescription drug plan costs, your monthly plan premium will be lower than what it would be if you did not get extra help from Medicare. The amount of extra help you get will determine your total monthly plan premium as a member of our Plan.

How Do Costs Change When You Qualify for Extra Help?

The extra help you get from Medicare will help you pay for your Medicare drug plan's monthly premium, yearly deductible, and prescription co-payments. The amount of extra help you get is based on your income and resources. If you qualify for extra help, we will send you by mail a low income subsidy (LIS) Rider for those who Receive Extra Help Paying for their Prescription Drugs that explains your costs as a member of our Plan. If the amount of your extra help changes during the year, we will also mail you an updated LIS Rider for those who Receive Extra Help Paying for their Prescription Drugs.

How Do You Know if You Qualify for Extra Help?

If you aren’t getting extra help, you can see if you qualify by calling:

  • 1-800-Medicare of TTY users call 1-877-486-2048 (24 hours a day/7 days a week),

  • Your State Medicaid Office, or

  • The Social Security Administration at 1-800-772-1213. TTY users should call 1-800-325-0778 between 7 a.m. and 7 p.m., Monday through Friday.

If you have any questions, please call Customer Service at 1-866-789-7747, (TTY: 1-866-264-4141) from 8 am to 8 pm Monday through Friday, and Monday through Sunday from 8 am to 8 pm between October 1 and February 14 (Pacific Time).

You may be able to get Extra Help to pay for your prescription drug premiums and costs. To see if you qualify for extra help, call: 1-800-MEDICARE (1-800-600-4227). TTY users should call 1-877-486-2048, 24 hours a day/7 days a week; The Social Security Office at 1-800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday. TTY users should call 1-800-325-0778; or your State Medicaid Office.


Soundpath Health

2018 Full Charter + Rx premium: $146.00 
2018 Full Sound + Rx premium: $40.00

Your level of Extra Help Your Charter + Rx Premium Your Sound + Rx Premium
100% $111.40 $9.80
75% $120.10 $17.30
50% $128.70 $24.90
25% $137.40 $32.40

For a downloadable version of this chart click here

Note: premiums listed are for both medical services and prescription drug benefits (MAPD plans only). Premiums listed do not include any Medicare Part B premium the member may have to pay.

The above income and resource amounts are for 2018 and will change in 2019. If you live in Alaska or Hawaii, or pay at least half of the living expenses of dependent family members, income limits are higher.

 

Other 
resources

Medicare Best Available Evidence (BAE) policy 
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Soundpath Health Appeals Document DOWNLOAD

 

Page Last Updated: October 01, 2017