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1129 Chapter 7:Worker guides • Section 6: MSP worker guides (07/2026) (updated each March). • Resources limited to $17,600 for an individual or $35,130 for a married couple living together in 2025. Resources include such things as bank accounts, stocks and bonds. We do not count their house, one car, or burial funds (up to $1,500) as resources. People with Medicare and Medicaid, Medicare Savings Program (MSP) enrollment, or those receiving Supplemental Security Income are automatically eligible for the extra help. People in these programs are “Deemed Eligible”. They do not need to apply for the LIS and do not need to meet the resource limit (as of 2016). If a person with Medicare loses their state medical assistance or MSP eligibility prior to July, they will no longer be automatically eligible for the extra help for the next calendar year. The individual must apply for the extra help with the Social Security Administration (SSA) to continue receiving low copayments for their Medicare Part D covered drugs for the following year. LIS effective dates The Low-Income Subsidy is effective the first day of the month of dual eligibility status. Example: An individual applies on August 10 but does not get all of the paperwork in until September 5 would have Medicaid effective on August 10 and LIS effective retroactively to August 1. The exception to this rule is for any individual “institutionalized” for MMA purposes. The institutionalized LIS Level 3 is not effective until the 1st of the month in which it is reasonably expected that the dual-eligible individual will remain in the facility for a full calendar month, in which Medicaid is paying. Example: A private pay individual in a facility meets the OSIPM criteria on May 7 and becomes a dual-eligible on that date. The LTC payments begin on that date, as well. It is believed that the individual will not be leaving the facility for several months. The LIS level 3 for this individual would begin on June 1. It is critical that the case is properly coded with the “ISI” case descriptors when it is anticipated that the individual will be in a facility for a full month. The “ISI” case descriptor can be viewed in MMIS and should be removed as soon as the individual leaves the facility. Choosing a Prescription Drug Plan (PDP) or a Medicare Advantage Plan (MA-PD) Unlike most of Medicare, private insurance plans offer prescription drug coverage. Plans choose drugs they will cover, their network pharmacies, and their monthly premiums. The plans must be approved by the Centers for Medicare and Medicaid Services (CMS) but each plan has flexibility in its design. Each plan has a list of covered drugs called a formulary. The list must include both brand name and generic drugs. People should review the plan materials carefully to make sure their drugs are covered and that their pharmacy is in the plan’s pharmacy network. These private Medicare plans can provide coverage: • A Stand-alone Prescription Drug Plan (PDP), covers the Medicare Part D prescription drugs only, and no other medical costs. • A Medicare Advantage Prescription Drug Plan (MA-PD) provides all Medicare benefits in one plan,