Extra Help for

Prescription Drugs

Peter OronaHealthcare Consultant

(602) 770-9062AZ License #1101008

4500 North 32nd Street, Suite 100EPhoenix, Arizona 85018

Disclaimer• Common Insurance Services Agency does not work for the US

Government or the Centers for Medicare & Medicaid Services

• The presentation is for general purposes only

• Each individual has their unique situation and maybe different from the next person

• You will need to contact your local Social Security office at 1 (800) 772-1213 & or Medicare at 1 (800) MEDICARE to verify your individual responsibilities & benefits

What is Extra Help?• Medicare’s “Extra Help”

program helps people with limited income pay for their prescription medications

• The Centers for Medicare & Medicaid Services estimates that more than 2 million people with Medicare may be eligible for Extra Help, but aren’t currently enrolled to take advantage of these savings

Extra Help - is also know as LIS = Low Income Subsidy

Many People Qualify & Don’t Know It

• Even if you were previously turned down for Extra Help due to income or resource levels, you should reapply.

• If you qualify, you’ll receive help paying for– Medicare Prescription Drug

Coverage Premiums– Copayments– Deductibles

To Qualify for Extra Help• To qualify for Extra Help, the Medicare

consumer must:• Have Medicare Part A and/or Part B• Reside in one of the 50 states or the

District of Columbia• Meet resource and income limits• Be a member of a Prescription Drug Plan

• $4,769 – is the AVERAGE spend on

prescription drugs

• $4,000*– Extra Help (LIS) Average Savings to

those who qualify

* http://www.ssa.gov/pubs/EN-05-10525.pdf

Extra Help - Automatic Qualifiers

• In certain situations, people will automatically qualify for Extra Help or LIS

• If you receive one of the following:– Full Medicaid Coverage– Partial Medicaid Coverage– Supplemental Security

Income– Help from Medicaid

(AHCCCS) paying for your Part B Premium

All other must APPLY for Extra Help

Qualifications for Extra Help

2015 Income Limits150% Federal Poverty Level (FPL)– Single Income

• $17,505.00 per year• $ 1,458.75 per month

– Married Income• $23,595.00 per year• $ 1,966.35 per month

• Sources of Income*– Wages– Social Security Income– Annuities

2015 Resource Limits– Single $13,440– Married $26,860

• Only two types of resources are used to see if you’re eligible for Extra Help– Liquid Assets– Real Estate (not home)

• Resources include– Bank Accounts & Cash– Stocks & Bonds & Mutual Funds– Annuities & IRA’s– Real Estate (not home)

• Resources DO NOT include– your HOUSE or the LAND on

which your home is located – Your personal vehicles

A recent law changed for how your income and assets are counted:

• Life insurance policies don’t count as resources

• Any help you get from relatives, friends, and others to pay for household expenses—like food, mortgage, rent, heating fuel or gas, electricity, water, and property taxes—doesn’t count as income

• Lowest Income & Resources– Pay no premiums or deductible – Small or no co-payments

• Slightly Higher Income & Resources– Pay a reduced deductible– Little more out of pocket

• If you qualify,– No Coverage Gap or Late Enrollment Penalty (LEP)– Continuous Special Enrollment Period (SEP)

Benefits of Extra Help

Extra Help

•Not Eligible for LIS• Standard plan premium & drug cost•Level 4 LIS• Not eligible for Medicaid• Reduced deductible, Pay 15% or less for drug• Low flat copay @ catastrophic coverage level• Varying Premium Subsidy• 25%, 50%, 75%, or 100%•Level 1 LIS• May be eligible for Medicaid•No deductible, Low flat copay for drug•$0 Copay @ catastrophic coverage level•100% Premium Subsidy

•Level 2 LIS• Eligible for Medicaid•No deductible, Lowest flat copay for drug•$0 Copay @ catastrophic coverage level•100% Premium Subsidy

•Level 3 LIS• Eligible for Medicaid & Institutionalized•No deductible, $0 Copay for Drug•100% Premium Subsidy

LowerIncome

HigherIncome

You Qualified Letter

No Cost to Apply

• There’s No Cost or Obligation to Apply

• It’s easy and free to apply for “Extra Help.”

We are here to help!Peter OronaHealthcare Consultant

(602) 770-9062