S had partial Extra Help, he would pay a 15% coinsurance for his prescription drugs or his plan’s standard copay. Your out-of-pocket costs also change when you reach catastrophic coverage ($6,550 out of pocket in 2021). For 2021, the resource limits for full LIS help are $7,970 if single and $11,960 if married, and the resource limits for partial LIS help are $13,290 if single and $26,520 if married. Medicare Savings Program clients, who do not also have full Medicaid, will always be in LIS Category 1. See the 2021 LIS Reference Sheet. Others with Limited Income. Other Medicare beneficiaries with limited income, including SNAP-only clients, may apply for the Low-Income Subsidy through the Social Security Administration (SSA). Unlike flat-fee copays, coinsurance is a percentage of the price of service you’ll pay. For example, after you have paid the Medicare Part B (medical insurance) deductible for the year ($203 in 2021), you will be required to pay 20 percent of each service covered by Part B, and Medicare pays the remaining 80 percent. Rx Tier 3 1 LIS copays Rx Tier 4 1 LIS copays Rx Tier 5 1 LIS copays Dental $2,500 comprehensive every year. $0 copay for routine exams Vision $0 copay for 1 routine vision exam every year, and a $400 eyewear allowance every 2 years. Hearing $0 copay for 1 routine hearing exam every year, and a $2,000 hearing aid allowance every 2 years.
- Lis Copays 2021 Income
- Lis Copays 2021 Application
- Lis Copays 2021
- Low Income Subsidy Copays 2021
- 2021 Extra Help Copays
Who Qualifies for 'Extra Help'?
For the plan year 2021 If your income is below $19,320 per year for a single person (or $26,130 for a married couple living together or even more if you have dependent children or grandchildren living with you), AND if your assets (resources) are below $13,290* for a single person (or $26,520* if you are married). *These limits do not include the $1,500 per person burial exclusion, see more details below.The following items are NOT included in income:
- Housing assistance,
- Medical treatment and drugs,
- Food stamp assistance, etc.
$1,500 per person Burial Exclusion:
All beneficiaries are permitted a $1,500 per person burial exclusion from their resources. This exclusion can be taken into account by either reducing your resources by $1,500 per person (Medicare & Your Handbook) or by increasing the resource limit by $1,500 per person (Most other Social Security Administration and Medicare documents). Below is a chart showing the resource figures with, and without taking into account the burial exclusion:
| Maximum Resource Limit | With $1,500 Burial Exclusion | Without $1,500 Burial Exclusion |
| Individuals | $14,790 | $13,290 |
| Couples | $29,520 | $26,520 |
The following items are included in resources:
- bank accounts,
- stocks and bonds,
- Real estate (other than your primary residence), etc.
- the house you live in,
- your car,
- other personal possessions such as your furniture and jewelry, etc.
- burial plots,
- up to$1,500 for burial expenses (per person), or
- life insurance policies.
Click on the year below to change the above qualification figures to the selected year:
202020192018201720162015201420132012201120102009200820072006
If you receive the full Extra-Help, full LIS, or are dual eligible for Medicare and Medicaid, there are Medicare Prescription Drug plans in your state the will qualify for the $0 monthly premium. Click on your state below to see PDP plans that qualify for the $0 premium:
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Who Should You Contact for 'Extra Help'?
Medicare Beneficiaries Who are interested in qualifying for financial 'extra help' with the Medicare Part D Prescription Drug plans should visit http://www.socialsecurity.gov/i1020Also see:
Low Income Subsidy Premium Table - 2021
If you get extra help from Medicare to help pay for your Medicare prescription drug plan costs, your monthly plan premium will be lower than what it would be if you did not get extra help from Medicare. The amount of extra help you get will determine your total monthly plan premium as a member of our Plan.
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This table shows you what your monthly plan premium will be if you get extra help.
Year 2021
Lis Copays 2021 Income
| Your Level of Extra Help | Monthly Premium for Vitality Plus (HMO)* | Monthly Premium for Inter Valley Health Plan Service To Senior (HMO), Desert Preferred Choice (HMO)* |
|---|---|---|
| 100% | $0.00 | $0.00 |
| 75% | $7.95 | $0.00 |
| 50% | $15.75 | $0.00 |
| 25% | $23.60 | $0.00 |
*This does not include any Medicare Part B premium you have to pay.
Inter Valley Health Plan’s premium includes coverage for both medical services and prescription drug coverage.
If you aren’t getting extra help, you can see if you qualify by calling:
- 1-800-Medicare or TTY users call 1-877-2048 (24 hours a day/7 days a week).
- Your State Medicaid Office, or
- The Social Security Administration at 1-800-772-1213. TTY users should call 1-800-325-0778 between 7 am and 7 pm Monday through Friday.
Lis Copays 2021 Application
If you have any questions, please contact our Pharmacy Care Team at 800-523-3142 or TTY 711
- From October 1 to March 31, you can call us 7 days a week from 8 am to 8 pm. We are closed on Thanksgiving day & Christmas day.
- April 1 to September 30, you can call us Monday through Friday, from 8 am to 8 pm. We are closed on Federal Holidays.
NOTE: When we are closed you have the option to leave a message. Messages received will be returned within one (1) business day.
The information is not a complete description of benefits. Contact the plan for more information. The actual complete terms and conditions of the health plan are set forth in the applicable Evidence of Coverage document.
Lis Copays 2021
For a PDF of this information please click here
Low Income Subsidy Copays 2021
H0545_FUY2021_032_C
2021 Extra Help Copays
Updated 10/05/2020