Help For Part D Drug Costs

Help for Part D drug costs is a different program from the Medicare Savings Program that helps people with Medicare costs.  Help for drug costs can be applied for at SSA.gov, while the Medicare Savings Program must be applied for through a state Medicaid office or website.

If a person applies through their state Medicaid office or website for help with their Medicare costs and is approved, the state will notify Social Security that the person qualifies for the Low Income Subsidy for their Part D premium and co-pays.

This information came from the Center for Medicare Advocacy.

The Part D Low-Income Subsidy

Full Subsidy:  Medicare Part D provides a full drug subsidy with low co-payments to Medicare beneficiaries with incomes up to 135% FPL and resources below $8,660 ($13,750 if married).  For those individuals, the 2014 eligibility limit is $1,312.88/month ($21,235.50 per year) for an individual; $1,769.63/month ($21,235.50/year) for a couple.

Partial Subsidy: Medicare Part D provides a partial subsidy of premium, deductible and co-insurance to Medicare beneficiaries with incomes up to 150% FPL and resources below $13,440 ($26, 860 if married). The income limit for this group is $1,458.75/month ($17,505/year) for an individual; $1,966.25/month ($23,595/year) for a couple.

As with the MSP monthly amounts, applicants should add $20 to account for the income disregard.

How this help reduces drug co-pays

If a person has “LIS”, she will pay only $6.65 (or less) for any brand name drug and $3.60 (or less) for generics – or 5% of the retail price for an expensive specialty drug.  This is a huge savings over “regular” Part D co-pays for brand drugs which range from $35 to $45 for a one-month supply. Specialty drug co-insurance is 33%. As an example, the full price of Humira is around $2,400 per month.

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