Some Medicare beneficiaries struggle to afford the high cost of prescription drugs. Although the Affordable Care Act (ACA) reduced the amount enrollees pay – to 25% – during the Medicare Part D donut hole, that amount still is more than some beneficiaries can afford.
Enrollees with limited incomes and resources can apply for Extra Help (Low-Income Subsidy, or LIS). This federal program dramatically lowers prescription drug expenses under Part D. The current income limit is $20,385 a year for singles and $27,465 a year for couples, and the asset limit is $15,510 for individuals and $30,950 for couples (these amounts are indexed each year to keep pace with the federal poverty level).
(Note that there are two levels of Extra Help; people with even lower income and assets can qualify for full Extra Help, while those with incomes up to the amounts listed here can qualify for partial Extra Help. Under the Inflation Reduction Act, which was enacted in August 2022, full Extra Help will be available as of 2024 for people with income and assets up to the level that had previously only qualified for partial Extra Help.)
State Pharmaceutical Assistance Programs (SPAPs) also provide prescription drug assistance to beneficiaries in some states. These programs can pay for Part D premiums, deductibles and co-pays. Income limits for SPAPs are usually much higher than Extra Help.