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Medicare Part D (prescription) stand-alone plan premiums can cost between approximately $6.00-$124.00 per month, for Medicare beneficiaries without coverage through active employment or employer-based retirement benefits.
The Social Security Administration (SSA) offers "Extra Help," also known as a Low Income Subsidy (LIS) to cover some Medicare Part D costs for stand-alone plans or Part D coverage within a Medicare Advantage Plan/Part C.
People who qualify for Extra Help/LIS may receive the following Part D assistance:
- help paying some or all of the monthly premium
- waived or reduced annual deductible
- lower pharmacy copays
- no coverage gap/donut hole
- may change Part D plans (or Part C if it has prescription coverage) more than once per year.
Note: Medicare beneficiaries enrolled in an active employer or retiree plan need to contact Social Security, their health plan, or plan administrator to discuss the risk of losing their active employer or retiree plan if approved for Extra Help/LIS. Approval may automatically sign you up for a Part D plan which will most likely cancel your employer or retiree coverage. You may not be able to get back the employer or retiree plan if this occurs.
To qualify for Extra Help/LIS Medicare beneficiaries need to meet income and asset criteria below.
- Assets do not include primary home, vehicle, burial expenses and some other assets.
- See this brochure from Social Security to learn about asset and income criteria.
1 Person Household for 2021:
- Gross Monthly Income: $1,610.00 ($19,320 yearly) or less AND
- Assets of $14,790 or less
2 Person Household for 2021 (married couple living together):
- Gross Monthly Combined Income: $2,177.00 ($26,130 yearly) or less AND
- Assets of $29,520 or less
If your income is higher than above, you still may be able to qualify. You may apply to find out for sure.
When approved for Extra Help/LIS you may also qualify for a Medicare Savings Program through the state of Washington. See this brochure for details about the 4 programs. The income and asset amounts listed will be updated in April, 2021 and will most likely increase slightly from what is listed in the current brochure.
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