This project was supported, in part by grant numbers 90SAPG0068, 2203CTMIAA and 2203CTMISH from the U.S. Administration for Community Living, Department of Health and Human Services, Washington, D.C. 20201. Grantees undertaking projects under government sponsorship are encouraged to express freely their findings and conclusions. Points of view or opinions do not, therefore, necessarily represent official Administration for Community Living policy. Revised February 15, 2023 Benefits Quick Guide CHOICES 1 (800) 994-9422 1. Medicare Savings Program (MSP) Effective 3/1/23-2/29/24 QMB Monthly Income Guideline • Single: $2,564 • Couple: $3,468 SLMB Monthly Income Guidelines • Single: $2,807 • Couple: $3,797 ALMB Monthly Income Guidelines • Single: $2,989 • Couple: $4,043 Important notes about MSP • There is no asset limit or estate recoupment for MSP. • Individuals who qualify for MSP and missed enrollment into Medicare A and/or B may be able to enroll into Medicare through MSP. For information on how to enroll into Medicare through MSP, click here. • Earned income disregard applies to income limits: For earned income, the first $65 and then half of the remainder is not counted toward eligibility. For more info on the Medicare Savings Program, click here. 2. Extra Help/Low Income Subsidy (LIS) Effective 1/1/23-12/31/23

Full LIS Level 1 copays (Medicare + MSP)

• Generic drugs: $4.15 • Brand Drugs: $10.35 Full LIS Level 2 copays (Medicare + HUSKY C)

• Generic drugs: $1.45 • Brand Drugs: $4.30 • Maximum out of pocket cost-sharing $17 per month Full LIS Level 3 copays (Medicare + Medicaid Waiver or SNF) • $0 cost-sharing

This project was supported, in part by grant numbers 90SAPG0068, 2203CTMIAA and 2203CTMISH from the U.S. Administration for Community Living, Department of Health and Human Services, Washington, D.C. 20201. Grantees undertaking projects under government sponsorship are encouraged to express freely their findings and conclusions. Points of view or opinions do not, therefore, necessarily represent official Administration for Community Living policy. Revised May 6, 2024 Benefits Quick Guide CHOICES 1 (800) 994-9422 1. Medicare Savings Program (MSP) Effective 3/1/24-2/29/25 QMB Monthly Income Guideline • Single: $2,649 • Couple: $3,595 SLMB Monthly Income Guidelines • Single: $2,900 • Couple: $3,935 ALMB Monthly Income Guidelines • Single: $3,088 • Couple: $4,191 Important notes about MSP • There is no asset limit or estate recoupment for MSP. • Individuals who qualify for MSP and missed enrollment into Medicare A and/or B may be able to enroll into Medicare through MSP. For information on how to enroll into Medicare through MSP, click here. • Earned income disregard applies to income limits: For earned income, the first $65 and then half of the remainder is not counted toward eligibility. For more info on the Medicare Savings Program, click here. 2. Extra Help/Low Income Subsidy (LIS) Effective 1/1/24-12/31/24

Full LIS Level 1 copays (Medicare + MSP)

• Generic drugs: $4.50 • Brand Drugs: $11.20 Full LIS Level 2 copays (Medicare + HUSKY C)

• Generic drugs: $1.55 • Brand Drugs: $4.50 • Maximum out of pocket cost-sharing $17 per month Full LIS Level 3 copays (Medicare + Medicaid Waiver or SNF) • $0 cost-sharing

This project was supported, in part by grant number 2302CTMIDR-00 from the U.S. Administration for Community Living, Department of Health and Human Services, Washington, D.C. 2025.

Benefits Quick Guide

Medicare Savings Program (MSP) Effective 3/1/26-2/28/27 QMB Monthly Income Guideline • Single: $2,807 • Couple: $3,806 SLMB Monthly Income Guidelines • Single: $3,073 • Couple: $4,166 ALMB Monthly Income Guidelines • Single: $3,272 • Couple: $4,437

Important notes about MSP + There is no asset limit or estate recoupment for MSP. + Individuals who qualify for MSP and missed enrollment into Medicare A and/or B may be able to enroll into Medicare through MSP. For information on how to enroll into Medicare through MSP, click here. + Earned income disregard applies to income limits: For earned income, the first $65 and then half of the remainder is not counted toward eligibility. For more info on the Medicare Savings Program, click here.

This project was supported, in part by grant number 2302CTMIDR-00 from the U.S. Administration for Community Living, Department of Health and Human Services, Washington, D.C. 2025.

Extra Help/Low Income Subsidy (LIS) Effective 1/1/26-12/31/27

Full LIS Level 1 copays (Medicare + MSP)

• Generic drugs: $5.10 • Brand Drugs: $12.15 Full LIS Level 2 copays (Medicare + HUSKY C)

• Generic drugs: $1.60 • Brand Drugs: $4.90 • Maximum out of pocket cost-sharing $17 per month Full LIS Level 3 copays (Medicare + Medicaid

Important notes about LIS: + MSP recipients automatically qualify for full LIS level 1. + Connecticut residents should consider applying for LIS through MSP because MSP has no asset restrictions and higher income guidelines. + Beneficiaries who have LIS will be randomly assigned to a benchmark Part D plan if they do not select a plan on their own. Beneficiaries with Extra Help who are enrolled in a benchmark plan will have a $0 monthly premium for their coverage. However, they still benefit from a plan comparison to determine the best plan that covers all their medications. + Individuals entitled to LIS who do not yet have a Part D plan can be eligible for immediate drug coverage through LI NET. For more information on LI NET and eligibility requirements, click here.