Medicare Part D Low Income Subsidy

Thousands of People on Medicare Part D in Connecticut
Are Eligible for Assistance But Have Not Applied

~ By Amy O'Connor
NAMI-CT
March 20, 2009

What is the Low-Income Subsidy?
The Low-Income Subsidy, also known as "Extra Help," provides financial assistance for some Medicare Part D beneficiaries who have limited income and resources. Those who are eligible for this low-income subsidy will get help paying for 75% or more of their monthly premium, yearly deductible, prescription co-insurance and co-payments and no gap in coverage.

NAMI-CT Offering to Host Presentations and Informational Tables

The National Alliance on Mental Illness of Connecticut (NAMI-CT) is holding presentations and staffing informational tables to raise awareness in the mental health community of the Low-Income Subsidy (LIS) available to some Medicare Part D beneficiaries who meet income and resources limits. NAMI-CT is eager to come out to clubhouses, provider and other interested groups to present and distribute information about the LIS and how to apply.

The LIS pays for 75% or more of prescription drug costs and in 2009 is estimated to be worth $3,923 at the pharmacy and as much as $298 in annual premiums. DSS estimates that there are 13,000 CT residents who don't know that they are eligible for the LIS!

To find out when and where presentations and informational tables are currently scheduled, or to request a presentation or table for your group, or to have flyers and applications mailed to you, contact Amy O'Connor at 1-800-215-3021 or email to policyassistant@namict.org.

The Centers for Medicare and Medicaid Services (CMS) encourages all Medicare Part D beneficiaries to apply for the Low-Income Subsidy, which in 2009 is estimated to be worth $3,923 at the pharmacy and as much as $298 in annual premiums. The Low-Income Subsidy can be critical for persons with mental illnesses who struggle to pay their Medicare Part D premiums and purchase needed medications. See the Low-Income Subsidy flyer (.pdf document, opens in a new browser window).

Why does the Low-Income Subsidy matter to Medicare Part D beneficiaries with mental illnesses?
Best treatment guidelines for mental health conditions require that patients have access to a wide array of available medications. Significant scientific and clinical evidence demonstrates that mental health medications are not generally interchangeable. Many drugs, even those within the same class, target different areas or chemicals in the brain and individual responses to medications may differ greatly and a drug's effectiveness and side effects hang on many factors, including the patient's race, ethnicity, gender, and other illnesses and medications. Because psychiatric drugs have unique and individualized effects on a person's health, the Low-Income Subsidy can be critical for those who are struggling to pay for their prescriptions, and can provide significant help in assuring that individuals have access to the specific medications recommended by their physicians. It is dangerous to the patient's health when psychiatric drugs are disrupted or discontinued, and is also costly to public health systems.

Who is eligible to receive the Low-Income Subsidy?
Some people are automatically eligible for the low-income subsidy. Those include people who are: full benefit dual eligibles (on Medicare and Medicaid); Supplemental Security Income (SSI) recipients with Medicare; and Medicare Savings Programs participants.

Others must apply through the Social Security Administration (SSA) to become eligible for the subsidy. Individuals with incomes up to $16,245 and married couples with incomes up to $21,855 may qualify for the subsidy, and if you support other family members or live in Alaska or Hawaii, this income limit may be higher. Eligibility also depends on an applicant's resources, including bank accounts, stock and bonds - NOT including your house or car. Individuals with resources up to $12,510 and married couples with resources up to $25,010 are eligible.

Generally, those eligible for the low-income subsidy pay no Part D plan premiums or deductibles, but pay $1.10 or $2.40 for generic drugs and $3.20 or $6.00 for brand-name drugs, depending on their income.

Connecticut's Department of Social Services (DSS) estimates that there are approximately 13,000 CT residents that are eligible for the low-income subsidy who are not currently receiving any "Extra Help." DSS wants to raise awareness of the Low-Income Subsidy in the mental health community, because access to medications for this population is so important, and for some access can be a life or death issue.

How can I apply for the Low-Income Subsidy?
People who are not automatically eligible have to fill out an application and send it to the Social Security Administration (SSA) or apply on-line at www.socialsecurity.gov.

You can also obtain applications from SSA by:

- Calling 1-800-772-1213 or (TTY) 1-800-325-0778
- Going to your nearest Social Security Office (find your local office)

Please download and share the Low-Income Subsidy flyer (.pdf document, opens in a new browser window).

For further information, please contact Amy O'Connor at policyassistant@namict.org or 1-800-215-3021.