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Medicare Part D Extra Help: What Agents and Beneficiaries Need to Know

When it comes to Medicare, prescription drug coverage can be a very confusing and expensive component for beneficiaries. Fortunately, there’s a federal program called Extra Help, also known as the Low-Income Subsidy (LIS), that can significantly reduce those costs. As a Medicare agent, you need to be able to answer the question; what’s Medicare part D Extra Help. Understanding and explaining this benefit can be a game-changer for your clients.

What Is Medicare Part D Extra Help

Extra Help is a program administered by the Social Security Administration (SSA) and Centers for Medicare & Medicaid Services (CMS) to assist individuals with limited income and resources in paying for their Medicare Part D prescription drug plan costs. This includes premiums, deductibles, and copayments.

The value of this benefit can be substantial—worth an average of about $5,300 per year (2024 estimate).

Who Qualifies for Extra Help?

To qualify for Extra Help, beneficiaries must meet certain income and resource limits. As of 2025 (these numbers are adjusted annually):

• Income Limits:
  • Individuals: Up to $23,715 annually
  • Married couples: Up to $31,965 annually
• Resource Limits (includes bank accounts, stocks, and bonds; excludes home, car, personal items):
  • Individuals: Up to $17,600
  • Married couples: Up to $35,130

Click here for a LIS Extra Help chart for 2025

Note: People who automatically qualify for Extra Help include those who:

• Have full Medicaid coverage
• Receive Supplemental Security Income (SSI)
• Qualify for an MSP (Medicare Savings Program)

What Extra Help Covers

Depending on the level of help a beneficiary qualifies for, Extra Help can:

• Reduce or eliminate monthly Part D premiums
• Lower or remove the annual Part D deductible
• Cap out-of-pocket drug costs

In most cases, those receiving Extra Help will pay:

• Low or no monthly premiums for a benchmark Part D plan
• A small deductible as low as $0
• Low copays (as little as $4.80 for generics and $12.15 for brand-name drugs in 2025) Full-Duals pay $1.60 for generic and $4.80 for brand name drug copays

Watch a quick YouTube video on the Quarterly SEP for Dual and Drug Help Elimination in 2025

How to Apply for Extra Help

• Online at www.ssa.gov/extrahelp
• By calling 1-800-772-1213 (SSA)
• Or by visiting the local Social Security office

As an agent, you can guide clients through the application process, help gather the right documentation, and verify eligibility.

Why Agents Should Care

Helping clients apply for Extra Help not only strengthens your relationship with them but also ensures they can afford necessary medications. When a client qualifies, they may be more willing and able to enroll in or stick with a Part D plan; making this an ideal opportunity to offer value and grow your book of business.

Agents, if you are ready to join the team at Crowe; click here for contracting

SEP for Extra Help Recipients

Don’t forget, beneficiaries who qualify for Extra Help are eligible for a Special Enrollment Period (SEP). This means they have an SEP to change their Medicare Part D plan once they are approved for extra help.

learn about the SEP Changes for Dual, Partial Dual and LIS members in 2025

Extra Help can be life-changing for Medicare beneficiaries who struggle with prescription drug costs. As an agent, your role in identifying eligibility and guiding your clients through the application process is crucial. It’s a win-win: clients get meaningful financial relief, and you build long-term trust and loyalty.

Stay updated on agent events and information; click here

Losing Medicaid benefits

Because of the recent Medicaid redetermination, many people are losing Medicaid benefits.

During the last 3 year period, Medicaid benefits have been automatically renewed for individuals who became eligible because of the public health emergency caused by COVID-19.  During this time, beneficiaries were not required to recertify annually for Medicaid coverage.

Because the public health emergency has ended or “unwinding” as of May 11, 2023, the requirement to recertify for Medicaid coverage is back in place.  This means there will not longer be any automatic renewal and Medicaid beneficiaries must prove the need for benefits.

In other words, beneficiaries will go through redetermination.

This process takes place each year and reviews each person’s need for health care assistance through their state government. It is important to reply to any valid communication you receive from your state’s department of Social Services or DSS.  If you fail to respond, you may lose your coverage even if you do qualify.

Each state has 1 year to begin the redetermination process starting on March 31, 2023.  All states must finish processing renewals within 14 months. In other words, beneficiaries may lose Medicaid coverage as soon as April 2023.

Millions of people will lose Medicaid coverage:

Although we do not know the exact number of people slated to lose coverage, it may be over 15 million.  For many employment is a main factor in their loss of Medicaid coverage.

Some individuals will lose coverage due to not confirming eligibility with their state’s DSS offices before the expiration of their coverage.  There also may be problems with a backlog of paperwork and a processing system that is simply overwhelmed.  This can cause delays and coverage loss.  This backlog has the potential to effect millions .  That is why it is best to be proactive and go into your Medicaid account to ensure you are still eligible and covered.

Click here to learn more about the unwinding of Medicaid’s continuous enrollment

What if I no longer qualify for Medicaid:

If you reapply for Medicaid and do not qualify, there are other low cost or even free healthcare choices available to you.  The choices depend on your personal circumstances.

1.  If either you or your spouse/partner has an employer that offers health insurance coverage, you may qualify to join during either their open enrollment period or with a special election period.
2. In the interim, if you are not yet eligible for employer based coverage, you can enroll in a short-term insurance plan while you wait to qualify.  There are several options for these types of plans.
3. You can also access healthcare through the healthcare marketplace.  In many cases, beneficiaries may qualify for a subsidy and pay a low monthly premium.   If you lose health coverage, you have a special enrollment period or SEP you can use to enroll in coverage.  To find the market place for your state go to healthcare.gov/marketplace-in-your-state.
4. College students may be able to purchase health coverage directly through a campus health plan. Students can get details from their registrar’s office.
5. If you are either 65 or older or have a qualifying disability, you may be eligible for health coverage through  Medicare.  Contact a licensed Medicare agent for help going over all your plan options.
6. Anyone who is either a veteran or an active duty service member may qualify for Tricare.  Use the following link to get more information: Tricare healthcare coverage.

It’s important to note that if you believe you qualify for Medicaid, you should reapply. We’ll discuss that next. But even if you do apply, you may need to explore some of the options above while you wait to be approved.

How do I reapply for Medicaid benefits:

If you have limited income/funds, you may be eligible to retain your Medicaid coverage.   If this is the case, Click here to for information on how to apply for Medicaid.  Contact your state DSS office for applications and guidance.

QMB Program CT

The QMB Program CT is an essential program available to Medicare beneficiaries who meet the income requirements and reside in Connecticut.  The QMB program provides the highest level of financial help to those who qualify.  It assures that beneficiaries can receive the medical care they need.

In some instances, Medicare beneficiaries may face significant out-of-pocket costs for their healthcare services. When this occurs, the Medicare Qualified Medicare Beneficiary (QMB) program provides much needed assistance.

What is the Medicare QMB program:

The Medicare QMB program is a state-administered program that helps Medicare beneficiaries who have a limited income pay for things such as; Medicare premiums, deductibles, coinsurance, and copayments. QMB stands for “Qualified Medicare Beneficiary,” this refers to people who meet certain income and asset criteria.

How do you qualify for the Medicare QMB program:

A person must be enrolled in Medicare Part A and Part B and have limited income and resources. In 2023, the income limit for QMB eligibility in Connecticut is $2,564 per month for individuals and $3,468 per month for married couples. There is no asset limit to qualify for this program.

The Medicare QMB program in Connecticut covers the following:

1. Medicare Part A premiums: Part A includes coverage for; inpatient hospital stays, skilled nursing facility care, hospice care, and home health care. The QMB program covers the monthly premium for Part A if either you or a spouse has not worked enough quarters to qualify for free Medicare Part A.
2. Medicare Part B premiums: This portion of Medicare covers doctor visits, outpatient care, preventive services, and medical equipment.
3. Deductibles, coinsurance, and copayments for covered services.
4. Medicare Advantage premiums: The QMB program covers the monthly premium for Medicare Advantage plans.
5. Part D prescription drug costs are covered by the QMB program.

There are 3 different levels of extra help available in CT:

As you will see, all three levels of MSP pay for the Medicare Part B premium.

1.  QMB is the highest level of help in CT.  If your monthly income is either at or below $2,564 (single) or $3,468 (couple), you may qualify for this level of extra help.  QMB program covers; Part B premium, Medicare deductibles as well as co-insurance.
2. SLMB is the next level of extra help in CT.  You may qualify for this level of help if your monthly income is either at or below $2,807 (single) or $3,797 (couple).  This level of help pays for your Part B premium only.
3. ALMB is the last level of extra help available to CT Medicare residents.  To qualify for this level of help, your monthly income must be either at or below $2,989 (single) or $4,043 (couple).  This program pays for your Part B premium only and is subject to available funding.  People who receive Medicaid are not eligible for this program.

When you are accepted into any of the three levels of MSP, you are automatically enrolled into the LIS (Low Income Subsidy).

This program is also called “Extra Help”.  LIS pays the cost of a Medicare Part D (prescription coverage) benchmark plan, or part of a non-benchmark plan.  LIS also pays your Part D annual deductible, co-insurance, or co-pays on your prescription medications.  This applies even if you reach the coverage gap.  Another benefit if LIS enrollment is, you are allowed a Special election period to change your MA or Part D plan anytime during the first 3 quarters of the year

To sum it up; the QMB program CT is a valuable resource for those who qualify and are struggling to pay their Medical costs.

How to apply for the Medicare QMB or MSP help in Connecticut?

You can apply for the Medicare QMB program in Connecticut by contacting either the State of Connecticut Department of Social Services (DSS) or the Medicare Savings Programs (MSP) unit. There are a few ways to apply; online, by mail, or in person.

To apply online,  visit the DSS website and complete an application. To apply by mail, just download an application from the DSS website.  You can schedule an in-person meeting by calling the MSP unit 1-800-842-1508.  Important: you must provide documentation of your income and assets, as well as your Medicare information.

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