2016 Medicare Low–Income Subsidy

Call us to find out if you qualify for a Low-Income Subsidy (LIS) — also known as Extra Help — to help pay for your premiums and prescription drug copayments.

How to apply

To get LIS, apply through Social Security or your State Medicaid Agency. Complete an online application or call the Social Security Administration directly Monday through Friday, 7 a.m. to 7 p.m. to apply at 1-800-772-1213 toll-free (TTY 1-800-325-0778).

How LIS changes your premiums and copayments

If you qualify, Medicare will tell us about your LIS eligibility and we will apply it to your coverage reducing your out of pocket costs. You can also tell us about your LIS. You can show us your Medicaid card or your award letter from SSA - these are called "Best Available Evidence". Learn more about "Best Available Evidence" by visiting the CMS website.

Monthly premium

Subsidy Levels Complete Complete Plus Standard Standard Plus Dual Care
Level 1 - 100% $43.80 $99.80 $126.80 $169.80 $0
Level 2 - 100% $43.80 $99.80 $126.80 $169.80 $0
Level 3 - 100% $43.80 $99.80 $126.80 $169.80 $0
Level 4 - 100% $43.80 $99.80 $126.80 $169.80 $0
Level 4 - 75% $50.30 $106.30 $133.30 $176.30 $6.50
Level 4 - 50% $56.90 $112.90 $139.90 $182.90 $13.10
Level 4 - 25% $63.40 $119.40 $146.40 $189.40 $19.60

Out-of-pocket drug costs

Subsidy Levels Annual Deductible Complete and Standard Annual Deductible Complete Plus and Standard Plus Copayment / Coinsurance* Catastrophic Copayment**
Level 1 - 100% $0 $0 $2.95/$7.40 $0/$0
Level 2 - 100% $0 $0 $1.20/$3.60 $0/$0
Level 3 - 100% $0 $0 $0/$0 $0/$0
Level 4 - 100% $74 $0 15% $2.95/$7.40
Level 4 - 75% $74 $0 15% $2.95/$7.40
Level 4 - 50% $74 $0 15% $2.95/$7.40
Level 4 - 25% $74 $0 15% $2.95/$7.40

* Copayment amounts for generic/preferred multi-source and other drugs, respectively. For example, the first amount shown ($2.95) is the copayment for a generic drug filled for a member who is in the LIS Category 1.

** After the True-Out-of-Pocket Limit is reached, the Catastrophic Copayment for LIS Levels 1, 2, & 3 is $0 for both generic and brand drugs. The Catastrophic Copayment amounts for LIS Level 4 are $2.95 for generic/preferred multi-source drugs and $7.40 for other drugs.

Note: Beneficiaries receiving extra help are responsible for paying the monthly premium amounts listed above. You must continue to pay your Medicare Part B premium.

HMSA Akamai Advantage is a PPO plan with a Medicare contract. Enrollment in HMSA Akamai Advantage depends on contract renewal. The benefit information provided is a brief summary, not a complete description of benefits. For more information, call us. Benefits, formulary, pharmacy network, premium, and/or copayments/coinsurance may change on January 1 of each year. You must continue to pay your Medicare Part B premium.