Medicare Part D

Lawrenceville Medicare Extra Help: who qualifies for LIS

LAWRENCEVILLE, Ga. — If prescription costs feel heavier than they should, there is a federal program many Medicare beneficiaries overlook. It's called Extra Help, also known as the Low-Income Subsidy, or LIS. It lowers what people with limited income and resources pay for their Part D prescription drugs — and thousands of Georgians who qualify never sign up.

Here in Lawrenceville, where Gwinnett County has a large and growing Medicare-eligible population, understanding Extra Help can make a real difference in how manageable monthly medications feel.

What Extra Help Actually Does

Extra Help is a federal program run by the Social Security Administration and Medicare. For people who qualify, it reduces or eliminates the Part D monthly premium and lowers the amount you pay at the pharmacy counter for covered drugs.

According to CMS — Medicare Part D program rules (medicare.gov), people with full Extra Help pay no Part D deductible and have set, low copays for generic and brand-name prescriptions. For reference, the Part D out-of-pocket cap is $2,100 in 2026 and $2,400 in 2027, and the maximum Part D deductible for people without the subsidy is $615 in 2026 and $700 in 2027.

Extra Help is not a separate insurance plan. It works alongside a Part D or Medicare Advantage drug plan you already have — or one you choose during enrollment.

Who Qualifies in 2027

Eligibility is based on your income and resources. Medicare updates the limits each year, but the general framework stays the same:

• You must have Medicare Part A and/or Part B.
• Your income must fall below a set threshold (roughly 150% of the federal poverty level).
• Your countable resources — like money in checking, savings, stocks, and bonds — must also fall under a set limit. Your home, one vehicle, personal belongings, and burial funds generally do not count.

As of 2024, Congress expanded Extra Help so that everyone who qualifies gets the full benefit — the old "partial" tier is gone. That change carries into 2027.

You may automatically qualify (no application needed) if you have Medicaid, get Supplemental Security Income (SSI), or receive help from a Medicare Savings Program. Everyone else needs to apply.

Common Mistakes to Avoid

A few missteps keep people from getting help they're entitled to:

• Assuming you make "too much." Many people who assume they won't qualify actually do. It costs nothing to apply.
• Counting the wrong assets. Your house and one car don't count. Some people disqualify themselves on paper before Social Security even reviews the application.
• Forgetting to reapply after a life change. A spouse's passing, a move, or a change in income can affect eligibility. If your situation changes, check again.
• Confusing Extra Help with a Medicare Savings Program. They're different. Extra Help covers drug costs; MSPs help with Part B premiums and other costs. You can qualify for both.
• Waiting for Annual Enrollment. You can apply for Extra Help any time of year — you don't have to wait for October 15.

How Local Plan Choices Fit In

Lawrenceville is in Gwinnett County, where beneficiaries typically have a wide range of stand-alone Part D and Medicare Advantage plans with drug coverage to choose from. Extra Help works with any of them, but the amount you pay at the pharmacy can still vary by plan formulary. If you get Extra Help mid-year, Medicare may enroll you in a benchmark plan automatically, though you're free to switch.

The Annual Enrollment Period (Oct. 15 – Dec. 7) and the Medicare Advantage Open Enrollment Period (Jan. 1 – March 31) are good moments to review whether your current drug plan still fits — especially if your prescriptions have changed.

Another Tool: The Medicare Prescription Payment Plan

Separate from Extra Help, all Part D enrollees now have the option of the Medicare Prescription Payment Plan. Instead of paying a large amount at the pharmacy at once, you can spread your drug costs across monthly payments during the plan year. It doesn't lower your total cost, but it can make big pharmacy bills easier to handle. It's optional, and you have to opt in through your drug plan.

How to Apply

There are three straightforward paths:

1. Online at ssa.gov/extrahelp. 2. By phone at 1-800-772-1213 (Social Security). 3. In person at your local Social Security office.

You can also get free, unbiased help from Georgia's SHIP program, GeorgiaCares, which counsels Medicare beneficiaries at no cost.