Page 91

91

2025 202620 Full Subsidy-Non-FBDE Beneficiaries (1)

Applied or eligible for QMB/SLMB/QI or SSI, income at or below 150% FPL for 2025 and resources ≤ $16,100 (individuals, 2025) or ≤ $32,130 (couples, 2025) [category code 1] (3)

Deductible $0.00 $0.00 Maximum Copayments up to Out-of-Pocket Threshold

Generic/Preferred Multi-Source Drug $4.90 $5.10 Other $12.15 $12.65 Retiree Drug Subsidy Amounts

Cost Threshold $590 $615 Cost Limit $12,150 $12,650 (1) The LIS eligibility categories and corresponding cost-sharing benefits are sometimes referred to using category codes as follows: • Category Code 1 – Non-institutionalized FBDE beneficiaries with incomes between 100% and 150% of FPL and full-subsidy-non-FBDE beneficiaries. • Category Code 2 – Non-institutionalized FBDE beneficiaries with incomes up to 100% of the FPL. • Category Code 3 – FBDE beneficiaries who are institutionalized or would be institutionalized if they were not receiving home and community-based services. (2) Per section 1860D-14(a)(1)(D)(i) of the Act, FBDE beneficiaries who are receiving certain home and community-based services qualify for zero cost sharing if the individuals (or couple) would have been institutionalized otherwise. (3) The resource limits for CY 2026 will be provided via the annual HPMS memo entitled “Calendar Year (CY) 2026 Resource and Cost-Sharing Limits for Low-Income Subsidy (LIS)” that is expected to be released during the usual timeframe after the September 2025 CPI has been made available by the Bureau of Labor Statistics. Additionally, these amounts are adjusted for beneficiaries that notified the SSA of their intent to use a portion of their resources for burial expenses. The CY 2025 resource limits, including $1,500 per person for burial expenses, are $17,600 ($35,130 if married). Also, beneficiaries that would have been eligible for the partial LIS benefit had the IRA not been enacted will be eligible for the full LIS benefit if they meet the resource standard described at section 1860D- 14(a)(3)(E) of the Act. Note that under 42 CFR 423.773(c)(2), full subsidy-eligible beneficiaries deemed eligible between January 1 and June 30 of a calendar year are deemed eligible for the remainder of the calendar year. Full subsidy-eligible beneficiaries deemed eligible between July 1 and December 31 of a calendar year are deemed eligible for the remainder of the calendar year and the following calendar year.