2017 Medicare Low–Income Subsidy

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

Apply for LIS at the Social Security Administration (SSA) or your State Medicaid Agency. Complete an online application at ssa.gov or call the SSA Monday through Friday, 7 a.m. to 7 p.m., at 1-800-772-1213 toll-free. For TTY, call 1-800-325-0778.

How LIS changes your premiums and copayments

If you qualify, Medicare will tell us about your LIS eligibility and we’ll apply it to your health plan benefits to reduce your out-of-pocket costs. You can also tell us about your LIS by showing us your Medicaid card or your award letter from SSA, called Best Available Evidence. Learn more about Best Available Evidence by visiting the CMS website at cms.gov.

Monthly premium

Subsidy Levels Complete Complete Plus Standard Standard Plus Dual Care
Level 1 - 100% $43.50 $131.50 $126.50 $175.50 $0
Level 2 - 100% $43.50 $131.50 $126.50 $175.50 $0
Level 3 - 100% $43.50 $131.50 $126.50 $175.50 $0
Level 4 - 100% $43.50 $131.50 $126.50 $175.50 $0
Level 4 - 75% $50.10 $138.10 $133.10 $182.10 $6.60
Level 4 - 50% $56.70 $144.70 $139.70 $188.70 $13.20
Level 4 - 25% $63.40 $151.40 $146.40 $195.40 $19.90

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 $3.30/$8.25 $0/$0
Level 2 - 100% $0 $0 $1.20/$3.70 $0/$0
Level 3 - 100% $0 $0 $0/$0 $0/$0
Level 4 - 100% $82 $0 15% $3.30/$8.25
Level 4 - 75% $82 $0 15% $3.30/$8.25
Level 4 - 50% $82 $0 15% $3.30/$8.25
Level 4 - 25% $82 $0 15% $3.30/$8.25

* Copayment amounts for generic/preferred multi-source and other drugs, respectively. For example, the first amount shown ($3.30) is the copayment for a generic drug filled for a member in the LIS Category 1.

** After the true-out-of-pocket limit is reached, the Catastrophic copayment for LIS Levels 1, 2, and 3 is $0 for both generic and brand drugs. The Catastrophic copayments for LIS Level 4 are $3.30 for generic/preferred multi-source drugs and $8.25 for other drugs.

HMSA Akamai Advantage is a PPO plan with a Medicare contract. Enrollment in HMSA Akamai Advantage depends on contract renewal.

This information is not a complete description of benefits. Contact the plan for more information. Limitations, copayments, and restrictions may apply. Benefits, premiums and/or co-payments/co-insurance may change on January 1 of each year.

You must continue to pay your Medicare Part B premium.