Low Income Subsidies

If you have limited resources and income, you may be eligible for a low-income subsidy (also called Extra Help), which helps pay your Medicare prescription coverage (lowers your premium payment amount), and in some cases, can help lower co-pay costs of prescriptions. This could add up to about $4,000 per year. How much lower your premiums may be depends on what percentage of the costs Medicare will cover for you.

Learn more about getting Extra Help.

Read about the Best Available Evidence for Low Income Subsidy (LIS) Beneficiaries.

You must receive all routine care from plan providers.

How to Apply

To see if you qualify for Extra Help:

• Call the Medicare offices 24 hours a day, 7 days a week
• 1-800-Medicare
• TYY/TDD users call 1-877-486-2048
• Visit the Texas Medicaid Office
• Call the Social Security Administration Monday through Friday, 7 a.m. to 7 p.m.
• 1-800-772-1213
• TTY/TDD users call 1-800-325-0778

Best Evidence Available for Income Subsidy (LIS) Beneficiaries

In accordance with the statutory requirement to provide a cost-sharing subsidy to Part D-eligible individuals who are full-benefit dual-eligible individuals or recipients of supplemental security income (SSI), Scott and White Health Plan (SWHP) must provide access to Part D drugs at the correct LIS cost-sharing level when presented with evidence of LIS eligibility, even if the sponsor’s systems and CMS’s systems do not yet reflect that eligibility.

We also must update our own systems to reflect the LIS status indicated by the best available evidence and, if necessary, must submit a request to CMS so that, for the deemed population, the agency’s systems can be updated as well. These requirements apply to all beneficiaries who are “deemed” subsidy-eligible (including full benefit Medicare/Medicaid eligibles, partial dual-eligibles and people receiving SSI) as well as those who must apply and are awarded LIS by the Social Security Administration (SSA).

For more information, and to see what forms of documentation are needed for evidence of low-income status:

• Review Best Available Evidence on the CMS website, or
• Contact Scott and White Prescription Services Customer Call Center at 1-800-728-7947, Monday — Sunday, 7:00 am — 8:00 pm CST or TTY/TDD users call 711