Low-Income Subsidies for Diabetes Supplies

Last updated: January 2025For those managing diabetes, understanding the available low income subsidies can be crucial in easing the financial burden.

Living with diabetes on a fixed income can be challenging, but there are several low income subsidies for diabetes supplies and care available through Medicare and other programs. We’ll help you understand your options and take steps to reduce your out-of-pocket costs.

This article provides general information about Medicare coverage and financial assistance programs. Always verify specific benefits with Medicare or your healthcare provider.

Understanding Low Income Subsidies for Diabetes Care

Medicare offers several programs to help beneficiaries with limited income afford their diabetes supplies and medications. The main program is called Extra Help (also known as the Low-Income Subsidy or LIS).

Key Benefits of Extra Help:

• Lower prescription drug costs
• Reduced or eliminated deductibles
• Lower copayments for diabetes supplies
• No coverage gap (‘donut hole’)

Do You Qualify for Extra Help?

For 2025, you may qualify for Extra Help if you have:

• Annual income below $22,590 (single) or $30,660 (married)
• Resources below $17,220 (single) or $34,360 (married)

Resources include: bank accounts, stocks, and bonds
Resources do NOT include: your home, car, or personal possessions

Real Stories: How Extra Help Changes Lives

Maria, 68: “Before Extra Help, I paid $180 monthly for insulin. Now I pay just $4.50. I can finally afford both my medications and groceries.”

James, 72: “My CGM supplies went from $60/month to $8.95. This program literally saved my life – I was skipping supplies before.”

Additional Programs for Diabetes Management

Beyond Extra Help, several other programs can assist with diabetes-related expenses:

Medicare Savings Programs (MSPs)

1. Qualified Medicare Beneficiary (QMB)

• Pays Medicare Part A & B premiums
• Covers deductibles and copayments
• Income limit: $1,255/month (single)

2. Specified Low-Income Medicare Beneficiary (SLMB)

• Pays Medicare Part B premiums only
• Income limit: $1,504/month (single)

3. Qualifying Individual (QI)

• Pays Medicare Part B premiums
• Income limit: $1,690/month (single)
• First-come, first-served basis

State-Specific Programs

Many states offer additional assistance programs for seniors with diabetes. Contact your State Health Insurance Assistance Program (SHIP) at 1-800-MEDICARE to learn about local options.

How to Apply for Extra Help

Step 1: Gather Your Documents

Before applying, collect:

• Social Security card
• Bank statements (last 3 months)
• Investment statements
• Medication list
• Income verification

Step 2: Choose Your Application Method

Online (Fastest)

• Visit www.ssa.gov/extrahelp
• Complete in about 30 minutes
• Get decision in 2-3 weeks

By Phone

• Call 1-800-772-1213
• TTY: 1-800-325-0778
• Monday-Friday, 8 AM – 7 PM

In Person

• Visit local Social Security office
• Bring all documents
• Get help completing application

Step 3: Complete the Application

The application asks about:

• Monthly income from all sources
• Bank account balances
• Investment values
• Life insurance policies
• Monthly expenses

Tip: Answer honestly – they verify information but want to help you qualify.

What Diabetes Supplies Are Covered?

With Extra Help and Medicare, you’ll get assistance with:

Medications

• Insulin (all types)
• Oral diabetes medications
• GLP-1 medications (Ozempic, Mounjaro)
• Blood pressure medications
• Cholesterol medications

Testing Supplies

• Blood glucose test strips
• Lancets and lancing devices
• CGM sensors and transmitters
• Ketone testing supplies

Medical Equipment

• Insulin syringes and needles
• Insulin pumps and supplies
• Glucose meters
• CGM receivers

Maximizing Your Benefits

1. Use Preferred Pharmacies

Some Medicare plans offer lower copays at preferred pharmacies:

• $0 copays for 90-day supplies
• Mail-order options available
• Local pharmacy networks

2. Generic Medications

When available, choose generic versions:

• Same effectiveness as brand names
• Significantly lower copays
• Automatic substitution at most pharmacies

3. Coordinate Programs

Stack your benefits:

• Extra Help + State programs
• Manufacturer assistance programs
• Pharmacy discount programs
• Community health center services

Frequently Asked Questions

“Will Extra Help affect my other benefits?”

No. Extra Help doesn’t count as income for:

• SNAP (food stamps)
• Housing assistance
• Medicaid
• Energy assistance

“What if I’m slightly over the income limit?”

Still apply! You may qualify if you:

• Support other family members
• Have high medical expenses
• Live in Alaska or Hawaii (higher limits)
• Have recent income changes

“How long does Extra Help last?”

• Continues as long as you qualify
• Social Security reviews eligibility periodically
• Report major changes in income/resources
• Reapply if you lose eligibility

“Can I get Extra Help if I have Medicare Advantage?”

Yes! Extra Help works with:

• Original Medicare
• Medicare Advantage plans
• Stand-alone Part D plans

Additional Resources for Low-Income Seniors

National Programs

1. Pharmaceutical Assistance Programs

• Direct from drug manufacturers
• Income requirements vary
• Visit NeedyMeds.org

2. Community Health Centers

• Sliding scale fees
• Free diabetes education
• Find at FindAHealthCenter.HRSA.gov

3. Area Agencies on Aging

• Local resource connections
• Benefits counseling
• Call 1-800-677-1116

Diabetes-Specific Help

American Diabetes Association

• Financial assistance resources
• 1-800-DIABETES

Partnership for Prescription Assistance

• Connects to 475+ programs
• www.pparx.org

Warning Signs You Need Financial Help

Don’t wait to apply if you’re:

• Skipping medications
• Reusing needles or lancets
• Not testing blood sugar regularly
• Choosing between food and supplies
• Accumulating medical debt

State-by-State Quick Reference

Generous States (Extra Benefits)

• New York: EPIC program
• Pennsylvania: PACE/PACENET
• New Jersey: PAAD program
• Connecticut: ConnPACE

States with Pharmacy Networks

• California: Medi-Cal assistance
• Texas: Kidney Health Care
• Florida: Senior Pharmacy Program

Tips from Seniors Who’ve Been There

Dorothy, 75: “Don’t be embarrassed to apply. I waited two years because of pride and suffered needlessly.”

Robert, 69: “Keep copies of everything. When I reapplied after losing eligibility, having documentation made it so much easier.”

Betty, 71: “Apply for everything you might qualify for. The worst they can say is no, but you might be surprised.”

Your Action Plan

This Week:

1. Check your current medication costs
2. Calculate your monthly income
3. Gather financial documents

Next Week:

1. Apply for Extra Help online or by phone
2. Contact SHIP for state programs
3. Talk to your pharmacist about preferred pharmacies

This Month:

1. Follow up on applications
2. Explore manufacturer programs
3. Set up automatic refills

Don’t Navigate This Alone

Remember, these programs exist to help you. There’s no shame in using benefits you’ve earned through years of paying into Medicare. Your health is too important to let cost be a barrier.

Signs You’re on the Right Track:

• Regular medication adherence
• Consistent blood sugar monitoring
• Less financial stress
• Better health outcomes

Need Help Applying for Subsidies?

Our specialists understand these programs and can guide you through the application process.

Call Now: 727-831-3729

Free assistance with Extra Help applications and Medicare coverage questions