Even if you don’t qualify for the extra help through Medicaid/Medi-Cal, you may still qualify for help paying for your Medicare prescriptions. This is because the Low Income Subsidy for the Part D drug plans have higher income and asset limits than the Medicare Savings Program.
Low Income Subsidy Medicare Prescription Drug Cost Help
Social Security administers the Part D prescription drug Low Income Subsidy program. Instead of a monthly income, used by Medi-Cal, Social Security uses your past year’s income. Social Security has access to your last filed federal tax return, verifying your income and potential eligibility. If you are determined eligible for the Low Income Subsidy for Part D, it will continue throughout the year.
Even though the Part D Low Income Subsidy eligibility has maximum income and asset limits, there are different levels of help within the program. Therefore, it is always best to at least check with Social Security to see if you are eligible for the extra help.
Income and Resource Limits 2022
Individual income maximum = $20,385, resource limit = $15,510
Married couple income maximum = $27,465, resource limit = $30,950
Resource Limits
Includes: money in checking, savings, and retirement accounts, stocks, bonds.
Not counted is: your home, one car, burial plot, up to $1,500 for burial expenses if you have put that money aside, furniture, other household and personal items.
Full and Partial Extra Help
There are 2 levels of extra help, full and partial. With full extra help, there is no plan premium, plan deductible (if the Part D plan has one), and prescription drug costs are capped at $4.15 for a 30 day supply of generics and $10.35 for brand-name drugs. Once the total drug costs (what you pay plus what the plan pays) equals $7,400, the drug costs are reduced to $0 for covered drugs.
If you qualify for the partial help level, if your Part D plan has a deductible, it will limited to $104. The cost of the prescriptions are limited to no more than 15 percent of the cost of the drug. If the copay for the drug is less than 15 percent, you would pay the lower copay. Once the total drug costs (what you pay plus what the plan pays) equals $7,400, generic drugs are limited to $4.15 for a 30 day supply and $10.35 for brand-name drugs.
Additionally, partial extra help can reduce the monthly premiums you pay for your Part D plan. Social Security may pick up 25, 50, or 75 percent of the plan premium. From the Social Security website, it is not real clear how the extra premium help is determined based on income and assets. Regardless, it is always best to at least apply at https://secure.ssa.gov/i1020/start. The worst that can happen is that you are declined, but you may qualify for some extra help.