Extra Help/Low Income Subsidy

Extra Help/Low Income Subsidy

Medicare Extra Help

Extra Help, also known as the Part D Low-Income Subsidy (LIS), is a federal program that helps pay the out-of-pocket costs of Medicare prescription drug coverage for people who have limited income and resources. Resources include your savings and stocks in your 401K or other retirement plan, but not your home or care.

If you qualify for Extra Help, you will get help paying for any Medicare drug plan’s monthly premium, yearly deductible, and drug copays.

Questions?

Call 1.833.276.8306
(TTY users should call 711)

October 1 to March 31, 8:00 am to 8:00 pm, 7 days a week and April 1 through September 30, Monday through Friday, 8:00 am to 8:00 pm.

On certain holidays your call will be handled by our automated phone system.

Do I qualify for Extra Help?

You qualify for Extra Help if:

  • You get full Medicaid benefits. You will be automatically enrolled in the Extra Help program. Medicare will mail you a letter with more information.
  • You get help from Medicaid paying your Medicare premiums, or if you receive Supplemental Security Income (SSI). You will be automatically enrolled in the Extra Help program, but you will need to enroll in a Medicare prescription drug plan.
  • You have limited income and resources and don’t get help from Medicaid. You can apply for Extra Help by calling Medicare toll-free at 1.800.MEDICARE (TTY 1.877.486.048), 24 hours a day/7 days a week.

 

Best Available Evidence (BAE)

The Best Available Evidence (BAE) policy makes sure that people getting Extra Help are not charged too much or have higher copays than they are supposed to.

The Centers for Medicare & Medicaid Services (CMS) requires that Medicare plans, like Community Health Choice (HMO D-SNP) accept Extra Help if you are eligible to receive it, even if your Medicare records don’t yet show it. Once you send Best Available Evidence to Community Health Choice, we will ask CMS to update your status in their system.

Some acceptable forms of Best Available Evidence are:

  • A copy of your Texas Medicaid card
  • A copy of a state document that shows you have Texas Medicaid
  • A print-out from a state electronic enrollment file or from your the Texas Medicaid system that shows you have Medicaid
  • A screen shot from the Texas Medicaid system showing your Medicaid status
  • Any other document from the state that shows you have Texas Medicaid
  • A Social Security Administration (SSA) Award Letter
  • An “Application Filed by Deemed Eligible” (SSA publication HI 03094.605) confirming that you are “automatically eligible for Extra Help”

Please visit Best Available Evidence to learn more about BAE policy. (Note: This opens to an external website)

2022 LIS Chart

The 2022 LIS Chart shows youi what your monthly plan premium will be if you get Extra Help.

Your level of extra help Monthly Premium for Community Health Choice (HMO D-SNP)
100%
$0.00
75%
$0.00
50%
$0.00
25%
$0.00

Need More Information?

Call Medicare:

  • 1.800.MEDICARE (1.800.633.4227)
    TTY 1.877.486.2048
    24 hours a day, 7 days a week
  • Visit Medicare online (Note: this opens to an external website)

Call the Social Security Office:

  • 1.800.772.1213 
    TTY 1.800.325.0778
    7:00 am – 7:00 pm, Monday – Friday
  • Visit Social Security online (Note: this opens to an external website)

Call the Texas THMP State Pharmacy Assistance Program (SPAP):

  • 1.800.255.1090 
    TTY 711
    8:00 am – 5:00 pm, Monday – Friday
  • Visit THMP online (Note: this opens to an external website)

Call Community Health Choice Member Services:

  • 1.833.276.8306 
    TTY 711

    October 1 to March 31, 8:00 am to 8:00 pm, 7 days a week and April 1 through September 30, Monday through Friday, 8:00 am to 8:00 pm.

    On certain holidays your call will be handled by our automated phone system.

Refer to your Evidence of Coverage for additional details on Extra Help/Low Income Assistance (LIS) and view the LIS premium chart located on the plan’s detail page. The chart will show you what your monthly plan premiums would be if you get Extra Help. 

H9826_IT_10045_092919_M Last updated October 4, 2021. ***Pending CMS Approval***

Why Choose Community?

As a local nonprofit health plan, Community Health Choice gives you plenty of reasons to join our Community. From the benefits and special programs we offer to the way our Member Services team helps you make the most of them, Community is always working life forward for you and your family.

“I always tell people to choose Community Health Choice. I tell them it’s the best health insurance they will ever be with.”
– Chandolyn
Member of Community Health Choice