Members

Low Income Subsidy

To be eligible for the Health Choice Generations HMO plan, you must meet certain eligibility criteria.

As part of the criteria, you must be enrolled in the state Medicaid program, AHCCCS. Additional enrollment information may be found under the Member Enrollment section of this website.

Social Security and the Centers for Medicare & Medicaid Services are working together to get you extra help with your prescription drug costs. To determine if you could be eligible for this extra help, Social Security will need to know your income and the value of your savings, investments and real estate (other than your home).

If you have limited income and resources, you may be able to get help paying for your monthly premiums, annual deductibles and prescription co-payments under the new Medicare prescription drug program that began January 1, 2006.

Once you receive extra help from Medicare, your premium will generally be lower. These premiums do not include any Part B premium amount you might have to pay and include both medical services and prescription drug benefits.

You may receive (or may have received) a letter from Medicare or the Social Security Administration (SSA) about your eligibility for extra help. Read this important information carefully. (If you don’t know what level of extra help you qualify for, you can call 1-800-MEDICARE (1-800-633-4227) for this information. TTY/TDD users should call 1-877-486-2048. Customer Service Representatives are available 24 hours a day, 7 days a week.) For information about Medicare’s Best Available Evidence Policy, please click here.

Frequently Asked Questions about Limited Income Subsidy Assistance (LIS)

Low -Income Subsidy Category Deductible

Copayment Up To Out-of-Pocket Threshold* 

Copayment Above Out-of-Pocket Threshold*

Institutionalized Full Benefit Dual Eligible; or 

Beneficiaries Receiving Home and Community-Based Services

$0 $0 $0
Full Benefit Dual Eligible ≤ 100% FPL

 

$0 $1.20 generic,
$3.70 brand
$0

Full Benefit Dual Eligible > 100% FPL; or

Medicare Saving Program Participant (QMB-only, SLMB-only, or QI); or 

Supplemental Security Income (but not Medicaid) Recipient; or

Applicant < 135% FPL with resources ≤$8,890 ($14,090 if married) **

$0 $3.30 generic
$8.25 brand
$0
Applicant < 150% FPL with resources between $8,890- $13,820 ($14,090 – $27,600 if married)** $82 15%

$3.30 generic, 
$8.25 brand

*Out-of-Pocket Threshold is $4,950 for 2017.
** Resource limits displayed include $1,500 per person for burial expenses. 

To qualify for extra help with Medicare prescription drugs plan costs in 2017, your annual income must be limited up to $18,090 for an individual ($24,360 for a married couple living together).

Even if your annual income is higher, you still may be able to get some help. Some examples where your income may be higher are if you or your spouse:

  • Support other family members who live with you
  • Have earnings from work; or
  • Live in Alaska or Hawaii

Not all cash payment count as income. For example, Social Security will not count:

  • Food stamp assistance;
  • Home energy assistance;
  • Medical case assistance;
  • Housing assistance;
  • Disaster assistance;
  • Earned income tax credit payments;
  • Victim’s compensation; and
  • Scholarships and education grants.

The 2017 resource limits are $7,390 ($11,090 if married) for the full low-income subsidy and $12,320 ($24,600 if married) for other low-income subsidies. If a beneficiary notifies the Social Security Administration (SSA) that he or she expects to use some of his or her resources for burial expenses, the resource limits are $8,890 ($14,090 if married) for the full low-income subsidy and $13,820 ($27,600 if married) for other low-income subsidies.

Resources include the value of the things you own. Some examples are:

  • Real estate (other than your primary residence);
  • Bank accounts, including checking, savings and certificates of deposit;
  • Stocks;
  • Bonds, including U.S. Savings Bonds;
  • Mutual funds;
  • Individual Retirement Accounts (IRAs); or
  • Cash at home or anywhere else.

Social Security does not count:

  • Your primary residence;
  • Your personal possessions;
  • Your vehicle(s);
  • Resources you could not easily convert to cash, such as jewelry or home furnishings;
  • Property you need for self-support, such as rental property or land you use to grow produce for home consumption;
  • Non-business property essential to your self-support;
  • Life insurance policies;
  • Burial expenses;
  • Up to $1,500 (or $3,000 if you are married and living with your spouse) of the cash value of life insurance policies you hold;
  • Burial spaces;
  • Interest earned on money you plan to use for burial expenses;
  • Certain other money you are holding is not counted for nine months, such as:
    • Retroactive Social Security or Supplemental – Security Income (SSI) payments;
    • Housing assistance;
    • Tax advances and refunds related to earned income tax credits and child tax credits;
    • Economic recovery payments
    • Compensation you receive as a crime victim; and
    • Relocation assistance from a state or local government

Even if you do not have all of your information or cannot find the documents, you should file for the extra help if you think you will be eligible. We will work with you to explain the information we need.

For more information about getting extra help with your prescription drug costs, call Social Security at 1-800-772-1213 (TTY 1-800-325-0778) or visit www.socialsecurity.gov.

If you need an application, also call Social Security, and ask for the Application for Help with Medicare Prescription Drug Plan Costs (SSA-1020). You can also apply online at: www.socialsecurity.gov.

To learn more about the Medicare prescription drug plans, call 1-800-MEDICARE (1-800-633-4227) or visit www.medicare.gov.

Medicare’s Best Available Evidence Policy Information: http://www.cms.hhs.gov.
Source: SSA Publication No. 05-10506, June 2007
Source: Medicare and You 2013 Publication



H5587_2017_41r2  CMS Approved 4/25/2017 Updated 04/26/2017

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