ASSISTANCE FOR PEOPLE WITH LOW INCOMES
Low Income Subsidy (LIS)
The Medicare Prescription Drug, Improvement and Modernization Act created a prescription drug
benefit through Medicare (called Medicare Prescription Drug Coverage or Part D). This law provides extra help
with the cost of prescription drugs for those who qualify. This extra help is known as the Low Income Subsidy (LIS) Program.
Do you qualify for extra help?
People with limited income and resources may qualify for extra help in one of two ways.
The amount of extra help you get will depend on your income and resources.
- You automatically qualify for extra help and don't need to apply if you have full coverage from a state
Medicaid Program like AHCCCS or get help from Medicaid paying your Medicare premiums or get supplemental security
income benefits. You do not need to apply for the extra help as Medicare mails letters to those who automatically qualify.
- You apply and qualify. If you think you may qualify you can call the Social Security Administration at (800) 772-1213 or visit www.socialsecurity.gov.
You may also apply at your State Medical Assistance (Medicaid) office.
Remember: Mercy Care Advantage members automatically qualify for this low income
subsidy because you have Medicaid (AHCCCS/ALTCS)!
How much do you pay for drugs covered by this Plan?
If you qualify for extra help with your drug costs, the cost for your
drugs would normally depend on your income and coverage levels, the type of drug it
is and whether you are filling your prescription at an in-network or out-of-network pharmacy.
To review the Eligibility and Benefits Table see below.
AHCCCS/ALTCS began paying all applicable Medicare Part D copayments on October 2006 for full
benefit dual eligible members. AHCCCS will continue paying these copays in 2008 as long as
you remain eligible for both Medicare and Medicaid.
As a dual eligible member enrolled in Mercy Care AHCCCS/ALTCS and in Mercy Care Advantage
, you will pay $0 for deductibles and copayments.
Table 1. Eligibility and Benefits, Part D Low-Income
Prescription Drug Subsidies, 2007
| |
|
|
Coinsurance/copayments
|
| Category or income/asset limits |
Premium assistance |
Deductible |
Below out-of pocket threshold |
Above out-of pocket threshold |
| Full subsidy groups |
| Full-benefit Medicaid or Medicare Savings Program beneficiary with income above 100% of FPL |
100% |
$0 |
$1 generic or preferred, $3.10 other* |
$0 |
| Full-benefit Medicaid or Medicare Savings Program beneficiary with income above 100% of FPL |
100% |
$0 |
$2.15 generic or preferred, $5.35 other |
$0 |
| Other beneficiary with income below 135% of FPL assets at or below $6,000 (individual), $9,000 (couple) |
100% |
$0 |
$2.15 generic or preferred, $5.35 other |
$0 |
| Partial subsidy groups |
| Income below 135% of FPL, assets $6,001-11,710 (individual), $9,001-23,410 (couple) |
100% |
$50 |
15% |
2.15 generic or preferred, $5.35 other |
| Income 135%-150% of FPL, assets at or below $11,710 (individual), $23,410 (couple) |
Sliding scale, 100%-0% |
$50 |
15% |
$2.15 generic or preferred, $5.35 other |
* No copayments for institutionalized beneficiaries.
** 135% of the FPG is $13,784 for an individual and $17,820 for a couple in 2007
*** 150% of the FPG is $18,482 for an individual and $20,535 for a couple in 2007.