Offer a $0 Drug Premium With

2013Medicare AdvantagePlans That

Offer a $0 Drug Premium with

Full Low-Income Subsidy (LIS)

County / Company Name / Plan Name / Plan’s Monthly Health Premium Beneficiary is still responsible for the plan’s monthly health & Part B premiums / Monthly Drug Premium / Annual Drug Deductible
Cook / Aetna Medicare / Aetna Medicare Value Plan (HMO) / $0 / $0 / $0
Cook / Blue Cross Blue Shield of IL, NM / Blue Medicare Advantage (HMO) / $0 / $0 / $325
Cook / HealthSpring, Inc. / HealthSpring Preferred (HMO-POS) / $0 / $0 / $0
Cook / HealthSpring, Inc. / HealthSpring Primary Plan (HMO) / $0 / $30.90 / $325
Cook / Humana Health Plan, Inc. / Humana Gold Plus H1406-013 (HMO) / $0 / $0 / $0
Cook / Humana Insurance Company / HumanaChoice R5826-009 (Regional PPO) / $64.70 / $24.30 / $325
Cook / UnitedHealthcare / AARP MedicareComplete Plus (HMO-POS) / $0 / $0 / $0
Cook / WellCare / WellCare Value (HMO-POS) / $0 / $0 / $0
DuPage / Blue Cross Blue Shield of IL, NM / Blue Medicare Advantage (HMO) / $0 / $0 / $325
DuPage / HealthSpring, Inc. / HealthSpring Preferred (HMO-POS) / $0 / $0 / $0
DuPage / HealthSpring, Inc. / HealthSpring Primary Plan (HMO) / $0 / $30.90 / $325
DuPage / Humana Health Plan, Inc. / Humana Gold Plus H1406-022 (HMO-POS) / $59 / $0 / $0
DuPage / Humana Health Plan, Inc. / Humana Gold Plus H1406-028 (HMO) / $0 / $0 / $0
DuPage / Humana Insurance Company / HumanaChoice R5826-009 (Regional PPO) / $64.70 / $24.30 / $325
Grundy / Humana Insurance Company / HumanaChoice R5826-009 (Regional PPO) / $64.70 / $24.30 / $325
Grundy / Universal American Corp. / Today's Options Premier Plus 650J (PFFS) / $76.90 / $30.10 / $130
Grundy / Universal Health Care Insurance Company, Inc. / Universal Any, Any, Any (PFFS) / $25 / $23.50 / $0
Kane / Blue Cross Blue Shield of IL, NM / Blue Medicare Advantage (HMO) / $0 / $0 / $325
Kane / HealthSpring, Inc. / HealthSpring Preferred (HMO-POS) / $0 / $0 / $0
Kane / HealthSpring, Inc. / HealthSpring Primary Plan (HMO) / $0 / $30.90 / $325

October 2012

County / Company Name / Plan Name / Plan’s Monthly Health Premium Beneficiary is still responsible for the plan’s monthly health & Part B premiums / Monthly Drug Premium / Annual Drug Deductible
Kane / Humana Health Plan, Inc. / Humana Gold Plus H1406-022 (HMO-POS) / $59 / $0 / $0
Kane / Humana Insurance Company / HumanaChoice R5826-009 (Regional PPO) / $64.70 / $24.30 / $325
Kane / UnitedHealthcare / AARP MedicareComplete Plus (HMO-POS) / $0 / $0 / $0
Kane / WellCare / WellCare Value (HMO-POS) / $0 / $0 / $0
Kankakee / Humana Insurance Company / HumanaChoice R5826-009 (Regional PPO) / $64.70 / $24.30 / $325
Kankakee / Universal American Corp. / Today's Options Premier Plus 650D (PFFS) / $89.60 / $28.40 / $85
Kankakee / Universal Health Care Insurance Company, Inc. / Universal Any, Any, Any (PFFS) / $25 / $23.50 / $0
Kankakee / WellCare / WellCare Value (HMO-POS) / $0 / $0 / $0
Kendal / Humana Health Plan, Inc. / Humana Gold Plus H1406-022 (HMO-POS) / $59 / $0 / $0
Kendal / Humana Insurance Company / HumanaChoice R5826-009 (Regional PPO) / $64.70 / $24.30 / $325
Lake / Humana Insurance Company / HumanaChoice R5826-009 (Regional PPO) / $64.70 / $24.30 / $325
McHenry / Humana Health Plan, Inc. / Humana Gold Plus H1406-022 (HMO-POS) / $59 / $0 / $0
McHenry / Humana Insurance Company / HumanaChoice R5826-009 (Regional PPO) / $64.70 / $24.30 / $325
McHenry / Universal American Corp. / Today's Options Premier Plus 650D (PFFS) / $89.60 / $28.40 / $85
McHenry / Universal Health Care Insurance Company, Inc. / Universal Any, Any, Any (PFFS) / $25 / $23.50 / $0
Will / Blue Cross Blue Shield of IL, NM / Blue Medicare Advantage (HMO) / $0 / $0 / $325
Will / HealthSpring, Inc. / HealthSpring Preferred (HMO-POS) / $0 / $0 / $0
Will / HealthSpring, Inc. / HealthSpring Primary Plan (HMO) / $0 / $30.90 / $325
Will / Humana Health Plan, Inc. / Humana Gold Plus H1406-013 (HMO) / $0 / $0 / $0
Will / Humana Insurance Company / HumanaChoice R5826-009 (Regional PPO) / $64.70 / $24.30 / $325
Will / UnitedHealthcare / AARP MedicareComplete Plus (HMO-POS) / $0 / $0 / $0
Will / WellCare / WellCare Value (HMO-POS) / $0 / $0 / $0

What is the Low-Income Subsidy?

The Low-Income Subsidy, also referred to as LIS or “Extra Help” is a federal prescription drug assistance program to help people with Medicare pay for their prescription drug costs. The Social Security Administration (SSA) processes LIS applications and determines eligibility and the Centers for Medicare and Medicaid Services (CMS) administers the program.

How does the Low-Income Subsidy (LIS) work with Medicare Advantage plans?

The LIS program provides the following benefits:

• Assistance with all or a portion of the monthly drug premium and deductible
• Low cost prescription drug co-payments at the pharmacy
• Part D donut hole (coverage gap) is eliminated

Beneficiary is responsible for:

• Plan’s Monthly Health Premium (covers medical and hospital benefits, and may cover extra benefits not usually covered by Original Medicare such as vision or dental)
• Part B Premium (unless enrolled in a Medicare Savings Program)
• Medicare Advantage co-pays or co-insurance amounts for each time a health service is used (e.g., primary care doctor co-pay or inpatient hospital stay co-pay)
• Prescription co-payments

Full LIS: between $1.10 and $6.50 for each 30-day supply filled

Partial LIS: $2.60, $6.50 or up to 15% coinsurance for each 30-day supply filled

Note: People who have both Medicare and Medicaid (called dual eligibles) and reside in a long-term care facility pay $0 co-pay for their prescription drugs. In addition, beginning in 2012, individuals who receive certain home and community based services will also pay $0 co-pays for their drugs.

How do I apply for LIS?

You may apply for LIS by submitting an application online through Social Security’s website at or by mailing in a paper application. Please contact Social Security at (800)772-1213 to request an application.

2012 Low-Income Subsidy (LIS)

Income and Asset Limits(As of October 2012)

Full Low-Income Subsidy

Individual / Couple
Income / $15,080 annually
($1,257 monthly) / $20,426 annually
($1,702 monthly)
Asset / $8,440* / $13,410*

Partial Low-Income Subsidy

Individual / Couple
Income / $16,755 annually
($1,396 monthly) / $22,695 annually
($1,891 monthly)
Asset / $13,070* / $26,120*

* Resource limits include $1,500 per person burial expenses

October 2012