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4 Table 2. CY 2026 Maximum LIS Beneficiary Cost-Sharing Table LIS Category Deductible Copayment up to Out-of-Pocket Thresholda

Generic Brand Full-Benefit Dual Eligible Beneficiaries Institutionalized or Receiving Home and Community-Based Services $0 $0 $0 Full-Benefit Dual Eligible Beneficiaries with income ≤ 100% FPL $0 $1.60 $4.90 Full-Benefit Dual Eligible Beneficiaries with income between 100% and 150% FPL $0 $5.10 $12.65 Non-Full Benefit Dual Eligible Beneficiaries Applied or are eligible for Medicare Savings Program (QMB-only, SLMB-only, or QI); or Supplemental Security Income (but not Medicaid) $0 $5.10 $12.65 Non-Full Benefit Dual Eligible Beneficiaries Applied and with income ≤ 150% FPL and resources ≤ $18,090 ($36,100 if married)b $0 $5.10 $12.65 Notes: a. The out-of-pocket threshold is $2,100 for 2026. Beginning in CY 2024, under section 1860D- 2(b)(4)(A)(i) of the Act, as amended by section 11201(a) of the IRA, there is no cost-sharing for covered Part D drugs above the annual out-of-pocket threshold, as defined at section 1860D- 2(b)(4)(B) of the Act, for any Part D beneficiaries, including LIS-eligible beneficiaries. b. The resource limits displayed include $1,500 per person for burial expenses. For beneficiaries who did not notify SSA that they expect to use some of their resources for burial expenses, the applicable resource limit is $16,590 ($33,100 if married).