Enhance the Medicare Part D Extra Help program
In accordance with the Inflation Reduction Act, signed into law in August 2022, the income guidelines for the Extra Help program will increase to allow people with an income of up to 150 percent of the federal poverty limit to qualify for help, beginning in 2024.
PAN’S POSITION
The Medicare Part D Low-Income Subsidy (LIS) program—also known as the Extra Help program—should be further enhanced to increase awareness and enrollment.
Congress and the administration should strengthen the LIS program, also known as Extra Help, to help more patients, eliminate cost-sharing for generic drugs, and facilitate the enrollment process. Increased efforts to ensure more people are aware of the program are needed. It is increasingly important to respond to the growing need for Medicare low-income enrollment assistance given the estimated 10,000 Americans turning 65 every day and older adults facing increasing debt and significant savings shortfalls.
The Extra Help program’s eligibility criteria requires patients to have an income under 150 percent of the federal poverty level and very limited assets. Because the income limits are low, millions of Medicare beneficiaries who are economically insecure are ineligible for extra help with their out-of-pocket medication costs. Further, the income and asset limits penalize seniors who have responsibly saved for retirement by counting retirement account disbursements as income or assets for purposes of Extra Help eligibility. Disbursements from defined contribution plans, such as 401(k) plans, IRAs, governmental 457(b) plans, and 403(b) plans should be excluded from eligibility determinations.
Lastly, many eligible patients do not enroll because of the program’s complexity. According to CMS, today, up to three million seniors and people with disabilities could benefit from the Extra Help program but are not currently enrolled. Specific outreach and enrollment efforts to ensure the program reaches the people who need it most are essential. This should include educating pharmacies on the permanent Limited Income Newly Eligible Transition (LINET) program that provides immediate, retroactive, temporary Part D prescription drug coverage through pharmacies for low-income Medicare beneficiaries not already enrolled in a Medicare drug plan.
