Low Income Subsidy (LIS)
LIS (Extra Help) — How It Works at the Pharmacy
LIS, also known as Extra Help, directly affects what you pay when you pick up prescriptions.
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What Changes at the Pharmacy When You Have LIS
When LIS is active on your Medicare record:
• Prescription copays are reduced
• Some medications may cost $0
• Deductibles are reduced or eliminated
• Late enrollment penalties for Part D are removed
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How the Pharmacy Sees LIS
Pharmacies see LIS through Medicare’s system.
• LIS applies automatically once approved
• You do not need a separate LIS card
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Important Pharmacy Notes
LIS only applies to covered drugs on your plan’s formulary.
Copays may differ based on:
• Generic vs brand medications
• Preferred vs non-preferred drugs
If a pharmacy says LIS isn’t active yet:
• Approval may still be processing
• A plan update may be required
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How Extra Help (LIS) Connects to D-SNP (Dual / Medicaid) Plans
Extra Help (also called LIS) helps reduce prescription drug costs, but LIS alone does not qualify someone for a D-SNP.
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How LIS May Indirectly Connect to D-SNP Eligibility
While LIS does not create D-SNP eligibility by itself, it can be a sign that someone may qualify for additional assistance, including Medicaid-related programs.
• Many individuals who receive LIS meet income guidelines for Medicare Savings Programs (MSPs)
• Medicare Savings Programs may help pay Medicare premiums and cost-sharing
• Some MSP levels include partial Medicaid benefits
• Individuals with Medicare and qualifying Medicaid coverage may be eligible for certain D-SNP plan levels, depending on state rules
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Important to Know
• LIS ≠ Medicaid
• LIS alone does not qualify someone for a D-SNP
• Medicare + qualifying Medicaid coverage may make someone eligible for certain D-SNP plan levels
• Eligibility and D-SNP levels vary by state and plan
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Why LIS Matters Even Without Full Medicaid
• LIS lowers prescription costs
• LIS provides Special Enrollment Periods
• LIS allows flexibility when transitioning into:
– Medicaid
– Medicare Savings Programs
– D-SNP plans when eligible
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Key Takeaway
• LIS = Prescription help
• Medicaid = Medical coverage
• D-SNP = Combined Medicare + Medicaid plan
LIS often acts as a bridge toward higher-level assistance.
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Qualifications (Income and Resource Limits Change Each Year)
• Income limits are set annually by Social Security and vary based on household size
• Resource limits are set annually by Social Security and exclude items such as a primary home or vehicle
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Where to Find the Current LIS (Extra Help) Limits
• Go to: https://www.medicare.gov/basics/costs/help/drug-costs
• Scroll down to the section
Learn more about Extra Help
Visit Medicare.gov (click it) for more information about the Extra Help program.
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Scroll down to "Who should apply for Extra Help?"
• Review the current limits for individuals and married couples
• If needed, use your browser search:
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Important Information & Disclosure
Anthony’s Healthcare provides health insurance education and guidance only. We are not affiliated with or endorsed by the U.S. government, the federal Medicare program, the Social Security Administration, or any state Medicaid agency.
Low Income Subsidy (Extra Help), Medicaid, Medicare Savings Programs, and Dual Eligible Special Needs Plans (D-SNP) are administered by Medicare, Social Security, or the appropriate state or federal agency. Eligibility, income limits, resource limits, covered services, prescription drug costs, copayments, and program availability vary based on individual circumstances, plan rules, and state guidelines.
Information provided on this website is for educational purposes only and does not guarantee eligibility, coverage, benefits, cost amounts, pharmacy pricing, or enrollment. Program rules, formularies, copayments, and eligibility requirements are subject to change.