Glossary: Prescription Drug Coverage

A federal law, sometimes called Obamacare, that has led to significant changes in the United States health care system, including extending health care coverage to many more Americans.

The maximum amount of assets you're allowed to own while maintaining eligibility for a particular disability benefits program. Most benefits programs do not count everything you own, including the home you live in and one car you own. For Supplemental Security Income (SSI), the first $100,000 in an ABLE account is not counted as assets. For Medical Assistance, SNAP (formerly Food Support/Food Stamps), and some other programs, none of the money in an ABLE account is counted.

Also called a "resource limit."

A set amount you have to pay when you receive medical services. For example, you may have to pay $30 every time you visit the doctor or $20 to get a prescription refilled. This is also known as a "copay."

Help paying for Medicare Part D for people with low to moderate income and assets. Also known as "Extra Help".

There are two levels of the Low Income Subsidy:

  • The full subsidy is for people who also get MA coverage or who are in a Medicare Savings Program (MSP). You may also qualify if your countable income is less than $17,388 per year and your assets are less than $9,470, if you are single (the limits are higher for larger households).
  • The partial subsidy is for people who can’t get the full subsidy, but have less than $19,320 in countable income and less than $14,790 in assets, if you are single (the limits are higher for larger households).
    • With the partial subsidy, you will pay 0%, 25%, 50%, or 75% of the Part D premium, depending on your income, and will only have to pay a $92 deductible before you get help paying for drugs. You will have to pay coinsurance and copayments for your medications, but they will be lower than they would be without the partial LIS.

Note: Not all of your income and assets are counted when you apply for the Low Income Subsidy. You can apply for the LIS even if you are not sure that you will qualify.

A state-run health care program that pays medical expenses for people who are disabled, young, elderly, poor, or pregnant. If you meet program requirements, MA will help pay for a variety of medical services including visits to the doctor, hospital stays, medical equipment, home care services, and prescription drugs. To apply for MA, visit your county or tribal human services office.

The part of Medicare that helps pay for prescription drugs.

The Medicare Part D Low Income Subsidy pays the monthly premiums for all benchmark plans. There are 7 such plans in Minnesota in 2021:

  • BCBS MedicareBlue Rx
  • First Health Part D Premier
  • HealthSpring Prescription Drug Plan
  • Humana Walmart – Preferred Rx Plan
  • Silverscript CVS Caremark Value
  • Sterling Rx
  • United Healthcare AARP Medicare Rx Preferred
  • Universal American Community CCRx Basic
  • WellCare Classic

Minnesota Senior Health Options (MSHO) is also considered a benchmark plan. If you have questions about Part D benchmark plans, Chat with a Hub expert.

An infection that occurs when the immune system is weakened.

A person who is HIV-positive, but does not have an AIDS diagnosis, Opportunistic Infections (OI), or any other symptoms. Somebody who is pre-disabled is likely to become disabled without medical treatment.

The doctor, nurse practitioner, or other medical service provider who is in charge of your medical care in a Health Maintenance Organization (HMO). In HMOs, you have to see a PCP in order to get a referral to see a specialist. Other types of health coverage might not have PCPs, or might charge you more if you see a specialist without getting a referral from a PCP.