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1128 Chapter 7:Worker guides • Section 6: MSP worker guides (07/2026) terminate State buy-in coverage. If the individual previously refused Part B of Medicare or withdrew from it, entitlement will be established or reestablished effective with the first month the individual is eligible for buy-in. When assistance is terminated and buy-in ends, the individual has the option to then withdraw the Part B coverage. If the individual does not withdraw, the Part B premium will be the base amount, even if the individual had been paying a higher penalty premium for late enrollment prior to being on buy-in. See here for more information on how buy-in works with ONE. Medicare Modernization Act Medicare prescription drug coverage, also called Medicare Part D, is available to anyone with Medicare Part A and/ or B. This includes people age 65 or older, and some younger people with disabilities. Any eligible person who wants to have Medicare prescription drug coverage has to enroll in a Medicare Prescription Drug Plan (PDP) or Medicare Advantage Prescription Drug Plan (MA-PD) that serves the area in which they live. Enrollment can be done through the plan or on Medicare’s web site, www.medicare.gov. When an individual becomes eligible for Medicare Part A or B, any medical coverage that the individual has through ODHS|OHA will change. People who have Medicaid (OHP Plus/OSIPM) will have very limited prescription coverage from the state after they become eligible for any portion of Medicare. Medicaid will pay for limited over-the-counter (OTC) medications. The Low-Income Subsidy (LIS) and copayments The amount a person pays depends on their income, whether they use generic or brand name drugs, and whether they are institutionalized or not. Individuals may fall into 3 categories for the Low-Income Subsidy (LIS). Full dual-eligible individuals with income above 100% of FPL fall into LIS Category 1, paying $4.90 for generic drugs and $12.15 for brand name drugs (in 2025). Those individuals with income at or below 100% of the federal poverty level fall into LIS Category 2, paying $1.60 for generic drugs & $4.80 for brand name (in 2025). Institutionalized and/or home and community-based, full-dual individuals fall into LIS Category 3, which eliminates copayments. Medicare Savings Program individuals, who do not also have full Medicaid, will always be in LIS Category 1. See the 2025 LIS Reference Sheet. Others with limited income Other Medicare beneficiaries with limited income, including SNAP-only individuals, may apply for the Low-Income Subsidy through the Social Security Administration (SSA). They complete the application form by providing their income, resources, and family size. Applications can be completed at www.ssa.gov. If the Social Security Administration determines that an individual is qualified for the extra help, they will fall within one of the categories outlined in the LIS Reference Sheet. The Social Security Administration does not have an Estate Recovery Program for any LIS assistance. If an individual falls within the following guidelines, they should be referred to SSA: • Annual Income limited to $22,590 for an individual or $30,660 for a married couple living together in 2025