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Partial Extra Help (*amounts include a $20 income disregard)

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Partial Extra Help (*amounts include a $20 income disregard)
Income between 135%-150% Federal Poverty Level (FPL)
▪ Individual $19,560 year/$1,630 month (2021)
▪ Couple $26,376 year/$2,198 month (2021)
▪ Asset test $14,790 (Individual) $29,520 (Couple) (2021)
o Includes $1,500 (individual) $3,000 (couple) for funeral/burial expenses
▪ Sliding scale premium
▪ Above 135% FPL but at or below 140% FPL, 75% premium subsidy
▪ Above 140% FPL but at or below 145% FPL, 50% premium subsidy
▪ Above 145% FPL but below 150% FPL, 25% premium subsidy
▪ $92 deductible (maximum in 2021) (maximum of $99 in 2022);
▪ 15% coinsurance up to TrOOP ($6,550 in 2021) ($7,050 in 2022); $3.70/$9.20 in 2021
($3.95/$9.85 in 2022)
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MEDICARE PRESCRIPTION DRUG COVERAGE (MEDICARE PART D)
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2021 HIICAP NOTEBOOK 6-7
Note: When applying for LIS/Extra Help directly with Social Security Administration, income
limits are higher for those beneficiaries that have dependent relatives living with them and
for whom the beneficiary (or spouse) provides at least ½ of their support.
Note: Beneficiaries whose income makes them eligible for Full Extra Help, but whose assets are
too high for Full Extra Help, can still receive Partial Extra Help if their assets fall below
Partial Extra Help limits. They will receive a mixed subsidy of Full Extra Help with the
premium and Partial Extra Help with their drug cost-sharing.
Note: Sometimes Extra Help recipients run into problems at the pharmacy counter if their Extra
Help status fails to display in the pharmacy’s computer system. When this happens, they
may be charged the “regular” cost sharing amount. The Best Available Evidence (BAE)
policy can be used to help beneficiaries get their copays adjusted to the correct amount.
Check the CMS publication If You Get Extra Help, Make Sure You’re Paying the Right
Amount https://www.medicare.gov/Pubs/pdf/11324-If-You-Get-Extra-Help.pdf for more
details.