Low Income Subsidy (LIS) Premium Summary Chart

If you qualify for extra help, Low Income Subsidy (LIS), to pay for your prescription drug costs, Medicare could also pay 75% or more of your Plan Premium, annual deductibles and co-insurance (if applicable).

Additionally, those who qualify won’t have a coverage gap or a late enrollment penalty.



To qualify, your yearly income is limited to $7,970 for an individual or $11,960 for a married couple living together.

icon PDF 2021 LIS Chart 


If your income and resources are slightly higher, you should still apply. You may still qualify if you meet one of the following conditions:

  • You or your spouse support other family members who live with you.
  • You or your spouse have earnings from work.
  • You or your spouse live in Alaska or Hawaii.

Your resources are limited to $13,440 for an individual or $26,860 for a married couple living together.  This information is based on 2013 Federal Poverty Levels (FPL).

If you currently have an Employer/Union health plan or a State Pharmacy Assistance Program (SPAP) it will not affect the help you receive paying for the prescriptions drugs.

The above charts show you what your monthly plan premium will be if you get this subsidy. The premiums listed above include both your medical and prescription drug coverage.

If your aren't getting extra help, you can see if you qualify by calling Member Services

Additionally, you may verify the details of qualification for extra help as well as review more information on extra help at the Centers for Medicare and Medicaid Services (CMS) website.

You may also call the following organizations to see if you qualify:

  • Medicare: (800) Medicare or (800) 633-4227
    TTY/TDD: (877) 486-2048, 24 hours a day/7 days a week.

  • Social Security Administration: (800) 772-1213
    TTY/TDD: (800) 325-0778, 7:00 a.m. - 7:00 p.m., Monday to Friday.

  • California's Medi-Cal office: (916) 552-9200 (TTY/TDD: None)
    8:00 a.m. - 5:00 p.m., Monday - Friday.

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