2011 Income Amounts for the Part D Prescription Drug Low Income Subsidy or “Extra Help”

The federal government recently released the federal poverty income levels (FPLs) for 2011, and they have increased slightly over 2010 levels, which will probably enable some beneficiaries to qualify for “Extra Help,“ particularly because Social Security payments did not automatically increase for 2011. The Low Income Subsidy or Extra Help allows Medicare beneficiaries with low incomes and resources who enroll in Part D to qualify for full or partial payment of their premiums, deductibles and reduces their co-payments on drugs. Full payment of the premium is restricted to plan premiums which are at or below the “benchmark” premium for your state.) This is fully explained in Chapter 7 (which begins on page 99) of Managing Your Medicare. Finally, these income amounts apply to the contiguous 48 states and the District of Columbia, the income levels (but not the resources levels) are higher for Alaska and Hawaii.


Those who qualify for Extra Help at these levels will pay no premium, and will not be subject to the deductible, and the cost of their drugs will be as follows:

If you have Medicaid AND:

You live in a nursing home:
You pay nothing.

Your income is at or below $10,890 (individual) or $14,710 (couple):
You pay $1.10 for a generic or preferred brand, and $3.30 for a non- preferred brand.*

Your income is above $10,890 (individual) or $14,710 (couple)
You pay $2.50 for a generic or preferred brand, and $6.30 for a non- preferred brand.*


You don't have Medicaid but your state helps you pay your Medicare premiums (that is, you are in the “Medicare Savings Program”) OR you get supplemental security income (SSI):
You pay $2.50 for a generic or preferred brand, and $6.30 for a non- preferred brand.*


You are not as above but qualify for Extra Help because of your income and resources levels are as follows:

If your income is below $14,702 (individual) or $19,859 (couple) & resources are at or below $8,180 (individual) & $13,020 (couple):
You pay $2.50 for a generic or preferred brand, and $6.30 for a non- preferred brand.*

If your income is below $14,702 (individual) or $19,859 (couple) & resources are
at or below $12,640 (individual) & $25,260 (couple):
You pay 15% of the cost of your drugs, plus you are subject to a $63 annual deductible.**

If your income is at or below $15,246 (individual) or $20,594 (couple) & resources are at or below $12,640 (individual) & $25,260 (couple):
You pay 15% of the cost of your drugs, plus you are subject to a $63 annual deductible, and you must pay 25% of your premium.**

If your income is below $15,791 (individual) or $21,330 (couple) & resources are at or below $12,640 (individual) & $25,260 (couple):
You pay 15% of the cost of your drugs, plus you are subject to a $63 annual deductible, and you must pay 50% of your premium.**

If your income is below $16,335 (individual) or $22,065 (couple) & resources are at or below $12,640 (individual) & $25,260 (couple):
You pay 15% of the cost of your drugs, plus you are subject to a $63 annual deductible, and you must pay 75% of your premium.**


*If your “drug expenses” ever exceed $4,550 in 2011, you will pay nothing for any prescription.

**If your “drug expenses” in the year ever exceed $4,550 in 2011, you will pay not more than $2.50 for a generic or preferred brand, and $6.30 for a non-preferred brand.

2011 Income Levels for Medicare Savings Programs

The federal government recently released the official federal poverty levels or “FPLs” for 2011. These income levels are key in two areas of Medicare. Here we discuss their effect on the Medicare Savings Programs, sometimes abbreviated as “MSP.” These are discussed in full beginning on page 16 of Managing Your Medicare. A separate posting will be made of the other key area, the Low Income Subsidy for Part D, also known as “Extra Help.”

Remember that you apply for the Medicare Savings Programs with your state’s Medicaid program, and that the resources you are permitted to have and still qualify have not changed in many years and are usually shown as $6,600 for an individual and $9,910 for a couple, but there are many exceptions and disregards both for resources, and for the income limits given below.

As the new income limits are different in both Alaska and Hawaii from the rest of the United States, in makes sense to give the 2011 income limits in three separate segments, as follows:

For the lower 48 states and the District of Columbia:

For the Qualified Medicare Beneficiary (QMB) program (which pays your Part B monthly premium, your annual deductibles and your Part B coinsurances), your income must be at or below 100 percent of the federal poverty level, which is now:

For an individual, $10,890 annually, or $908 monthly.
For a couple, $14,710 annually, or $1,226 monthly.
For each additional person in a family, add $3,820 annually, or $318 monthly.

For the Specified Low-Income Medicare Beneficiary (SLMB) program (which pays your Part B monthly premium), your income must be at or below 120 percent of the federal poverty level, which is now:

For an individual, $13,068 annually, or $1,089 monthly.
For a couple, $17,652 annually, or $1,471 monthly.
For each additional person in a family, add $4,584 annually, or $382 monthly.

For the Qualified Individual (QI) program (which pays your Part B monthly premium), your income must be at or below 135 percent of the federal poverty level, which is now:

For an individual, $14,702 annually, or $1,225 monthly.
For a couple, $19,859 annually, or $1,665 monthly.
For each additional person in a family, add $5,157 annually, or $430 monthly.

For the Qualified Disabled & Working Individuals (QDWI) program (which pays your Part A monthly premium), your income must be at or below 200 percent of the federal poverty level, which is now:

For an individual, $21,780 annually, or $1,815 monthly.
For a couple, $29,420 annually, or $2,452 monthly.
For each additional person in a family, add $7,640 annually, or $637 monthly.


For Alaska:

For the Qualified Medicare Beneficiary (QMB) program (which pays your Part B monthly premium, your annual deductibles and your Part B coinsurances), your income must be at or below 100 percent of the federal poverty level, which is now:

For an individual, $13,600 annually, or $1,133 monthly.
For a couple, $18,380 annually, or $1,532 monthly.
For each additional person in a family, add $4,780 annually, or $398 monthly.

For the Specified Low-Income Medicare Beneficiary (SLMB) program (which pays your Part B monthly premium), your income must be at or below 120 percent of the federal poverty level, which is now:

For an individual, $16,320 annually, or $1,360 monthly.
For a couple, $22,056 annually, or $1,838 monthly.
For each additional person in a family, add $5,736 annually, or $478 monthly.

For the Qualified Individual (QI) program (which pays your Part B monthly premium), your income must be at or below 135 percent of the federal poverty level, which is now:

For an individual, $18,360 annually, or $1,530 monthly.
For a couple, $24,813 annually, or $2,068 monthly.
For each additional person in a family, add $6,453 annually, or $538 monthly.

For the Qualified Disabled & Working Individuals (QDWI) program (which pays your Part A monthly premium), your income must be at or below 200 percent of the federal poverty level, which is now:

For an individual, $27,200 annually, or $2,267 monthly.
For a couple, $36,760 annually, or $3,063 monthly.
For each additional person in a family, add $9,560 annually, or $797 monthly.


For Hawaii:

For the Qualified Medicare Beneficiary (QMB) program (which pays your Part B monthly premium, your annual deductibles and your Part B coinsurances), your income must be at or below 100 percent of the federal poverty level, which is now:

For an individual, $12,540 annually, or $1,045 monthly.
For a couple, $16,930 annually, or $1,411 monthly.
For each additional person in a family, add $4,390 annually, or $366 monthly.

For the Specified Low-Income Medicare Beneficiary (SLMB) program (which pays your Part B monthly premium), your income must be at or below 120 percent of the federal poverty level, which is now:

For an individual, $15,048 annually, or $1,254 monthly.
For a couple, $20,316 annually, or $1,693 monthly.
For each additional person in a family, add $5,268 annually, or $439 monthly.

For the Qualified Individual (QI) program (which pays your Part B monthly premium), your income must be at or below 135 percent of the federal poverty level, which is now:

For an individual, $16,929 annually, or $1,411 monthly.
For a couple, $22,856 annually, or $1,905 monthly.
For each additional person in a family, add $5,927 annually, or $494 monthly.

For the Qualified Disabled & Working Individuals (QDWI) program (which pays your Part A monthly premium), your income must be at or below 200 percent of the federal poverty level, which is now:

For an individual, $25,080 annually, or $2,090 monthly.
For a couple, $33,860 annually, or $2,822 monthly.
For each additional person in a family, add $8,780 annually, or $732 monthly.



Note on resources: Technically, the resource limits for these programs are $4,000 for an individual and $6,000 for a couple, but because of disregards and exceptions, they are usually shown as $6,600 and $9,910, respectively. Again, the best advice is, because of disregards and exceptions, not to speak of differing states’ interpretations and waivers, if a beneficiary is ANYWHERE near the income and resource limits, they should apply for these programs.

Special Election Period for Beneficiaries Who Lost Part D Prescription Drug Coverage on January 1, 2011 Because their Plan Left the Medicare Program

The Centers for Medicare & Medicaid Services has extended a special election period for Medicare beneficiaries whose Part D prescription drug coverage ended with December 31, 2010, either because their stand-alone prescription drug plan (PDP) or their Medicare Advantage Plan with prescription drug coverage (MA-PD) left the Medicare program on January 1, 2011. These beneficiaries now have until February 28, 2011 to sign up for either a Medicare prescription drug plan (PDP) or a Medicare Advantage Plan with prescription drug coverage (MA-PD). Beneficiaries who do this will be enrolled effective with March 1, 2011. You can call 1-800-MEDICARE to do this.

Medicare Insider is now at this new address

Please visit the Medicare Insider at his new location!