Monthly premium
| Subsidy Levels | Complete | Complete Plus | Standard | Standard Plus | Dual Care |
|---|---|---|---|---|---|
| Level 1 - 100% | $0 | $93.90 | $8.90 | $133.90 | $0 |
| Level 2 - 100% | $0 | $93.90 | $8.90 | $133.90 | $0 |
| Level 3 - 100% | $0 | $93.90 | $8.90 | $133.90 | $0 |
| Level 4 - 100% | $0 | $93.90 | $8.90 | $133.90 | $0 |
| Level 4 - 75% | $0 | $101.70 | $16.70 | $141.70 | $6.00 |
| Level 4 - 50% | $0 | $109.40 | $24.40 | $149.40 | $12.00 |
| Level 4 - 25% | $0 | $117.20 | $32.20 | $157.20 | $18.00 |
Out-of-pocket drug costs
S had full Extra Help and a monthly income below $1,094, his copays would be $1.30 for generics and $4.00 for brand-name drugs, making his generic Extra Help copay less costly than the plan copay of $1.35. This means that Mr. S would pay the Extra Help copay throughout the year. People with Medicare can enroll in a Medicare prescription drug plan and receive extra help paying for the premiums, deductibles, gaps in coverage and co-pays. Click here to apply with the Social Security Administration. View the SHIIP Extra Help brochure for resource limits. View the 2021 Standard Part D Benefit. View the 2021 Stand-Alone Part. UPDATED 1.22.2021. 2021 Extra Help/LIS copay levels & costs. People on these programs are “deemed” eligible for LIS – they don’t need to apply! Beneficiary group Monthly income. Monthly premium. Annual deductible. Total covered spending: ≤$9,314 $9, 314 Income and assets vary by program rules Full Medicaid.
| Subsidy Levels | Annual Deductible Complete, Standard, and Dual Care | Annual Deductible Complete Plus and Standard Plus | Copayment / Coinsurance* | Catastrophic Copayment** |
|---|---|---|---|---|
| Level 1 - 100% | $0 | $0 | $3.70/$9.20 | $0/$0 |
| Level 2 - 100% | $0 | $0 | $1.30/$4 | $0/$0 |
| Level 3 - 100% | $0 | $0 | $0/$0 | $0/$0 |
| Level 4 - 100% | $92 | $0 | 15% | $3.70/$9.20 |
| Level 4 - 75% | $92 | $0 | 15% | $3.70/$9.20 |
| Level 4 - 50% | $92 | $0 | 15% | $3.70/$9.20 |
| Level 4 - 25% | $92 | $0 | 15% | $3.70/$9.20 |
- Home / Health Plans / HMSA Medicare Advantage / 2021 Extra Help / Extra Help LIS Premium Summary Chart. Print Share Extra Help LIS Premium Summary Chart. Low Income Subsidy tables for 2021 Monthly premium. Subsidy Levels Complete Complete Plus Standard Standard Plus Dual Care; Level 1 - 100%: $0: $93.90: $8.90: $133.90: $0: Level 2 - 100%.
- 2021 Extra Help/LIS copay levels & costs (Income amounts will be updated approx. 2021 to reflect 2021 FPLS) People on these programs are “deemed” eligible for LIS – they don’t need to apply! Beneficiary group Monthly income. Monthly premium. Annual deductible. Total covered spending.
* Copayment amounts for generic/preferred multi-source and other drugs, respectively. For example, the first amount shown ($3.70) 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 $3.70 for generic/preferred multi-source drugs and $9.20 for other drugs.
You must continue to pay your Medicare Part B premium.
HMSA Disclaimer
- HMSA Akamai Advantage is a PPO plan with a Medicare contract. Enrollment in HMSA Akamai Advantage depends on contract renewal.
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/i1020Extra Help 2021 Income Limits
Also see:
Extra Help Copays 2021