Main Takeaways
- The Low-Income Subsidy, or "Extra Help," significantly reduces prescription drug costs for 14 million Medicare beneficiaries with limited income and resources.
- The Inflation Reduction Act eliminated the partial LIS program, making full benefits available to individuals with incomes up to 150% of the federal poverty level.
- A New England Journal of Medicine study found that losing Medicaid—and with it, automatic LIS eligibility—was associated with increased mortality, especially among high-need patients.
Data show that 14 million Medicare beneficiaries currently receive the Low-Income Subsidy (LIS), which is intended to decrease cost sharing in Medicare Part D.1
As noted by Amy Niles, PAN Foundation’s chief mission officer in a column for Pharmaceutical Commerce,2 the program—also known as “Extra Help”—"helps those enrolled in Medicare Part D who have very limited income and assets to pay for the monthly premiums, annual deductibles, and copays related to their Rx medications.”
There were originally two programs within Extra Help (full and partial programs), with each of them based on income levels. However, there was change that went into effect via the Inflation Reduction Act (IRA) last year that removed the partial program, signifying that individuals with income up to 150% of the federal poverty level with limited resources may now be eligible for full benefits under the program.2
Keeping that in mind, the value of the LIS cannot be overstated, and losing it could impact medication access and ultimately, mortality. A study published in the New England Journal of Medicine sought to truly identify its impact.2
Gathering and analyzing the data
Using Medicare data spanning from 2015 to 2023, study investigators identified dual-eligible Medicare–Medicaid beneficiaries, who automatically receive the LIS, and calculated the yearly rates of Medicaid and LIS loss. From there, they dove into the potential connection between LIS loss and mortality by studying a natural experiment that developed from the relationship between Medicaid enrollment and LIS eligibility.
The study compared beneficiaries disenrolling from Medicaid in January through June of those specified years, who kept the LIS through December (six to 11 more months), with those disenrolling in July through December, who kept the LIS through the following December (12 to 17 additional months). Among individuals who disenrolled from Medicaid during 2015–2017, the study authors explored the collective mortality seven to 17 months following disenrollment, a timeframe representing when those with earlier disenrollment were more likely to lose the LIS. It’s also important to note that Medicare beneficiaries with Medicaid are automatically eligible for the LIS.
The study included a total of 969,606 individuals who lost Medicaid coverage in the first half of the year (January to June) and 920,158 who lost coverage in the second half (July to December). On average, those who lost Medicaid early had 13.6 months of LIS coverage over the 17 months after disenrollment, while those with later disenrollment had 15.3 months.
Seventeen months after losing Medicaid, the cumulative death rate was higher for individuals with early disenrollment (78.3 deaths per 1,000 people), compared to 75.3 per 1,000 among those with later disenrollment. This represents a difference of 3.0 deaths per 1,000 individuals (95% confidence interval, or CI, of 2.1 to 3.9). The mortality gap was even more pronounced among those in the highest quintile of initial Part D prescription drug spending (5.6 additional deaths per 1,000; 95% CI: 3.3 to 7.9) and among people using medications for cardiovascular disease, chronic lung disease, or HIV.
As a result, investigators concluded that the loss of drug subsidies following Medicaid disenrollment was associated with higher mortality among low-income Medicare beneficiaries.
References
1. Roberts ET, Phelan J., Schwartz AL, Meara E, Ruggiero D, Estenson L, Werner RM, Figueroa JF. Loss of Subsidized Drug Coverage and Mortality among Medicare Beneficiaries. N. Engl. J. Med. 2025 May 14. doi:10.1056/NEJMsa2414435
2. Niles A. A Look at the Medicare 'Extra Help' Program. Pharmaceutical Commerce. February 5, 2024. Accessed May 20 2025. https://www.pharmaceuticalcommerce.com/view/a-look-at-the-medicare-extra-help-program
