Page 1

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