320-8 Medicare Low-Income Subsidy

Effective Date: January 1, 2010

(395 was renumbered to 320-8 as of November 1, 2017)

Contact DHHS Policy Specialist for Previous Policy

The purpose of the Low Income Subsidy is to provide extra help paying for prescription drugs on Medicare Part D. There are three groups eligible for the subsidy:

Group 1: All members who receive Medicare (223-1) and Medicaid or who are enrolled in a Medicare Cost Sharing Program are eligible to receive a Low Income Subsidy benefit for Medicare Part D.

Group 2: Members with income less than 135% FPL, based on countable household size, AND assets under the countable limit. See Table II Each individual can designate up to $1500 for burial funds which increases the above asset limits by the designated amount.
Group 3: Members with income less than 150% FPL, based on countable household size, AND assets under the countable limit See Table II Each individual can designate up to $1500 for burial funds which increases the above asset limits by the designated amount.

Groups 2 and 3

Household size, countable income and countable assets for the second and third groups do not follow policy for A, B and D Medicaid programs or the Medicare Cost Sharing program.

Eligibility for Medicare Part A and/or enrollment in Medicare Part B is required for groups 2 and 3. Eligibility for these groups will reduce the required premiums, annual deductible and co-payments for Medicare Part D.

Social Security has primary responsibility for enrollment for Group 2 and 3. All applications for the Low Income Subsidy have a self addressed and stamped envelope to send the application to Social Security. States are required to have the ability to process applications for these groups on a restricted basis.

Further questions regarding application requirements and processing by the state should be directed to the authorized staff.