Why Your Prescription Costs Changed on a Medicare D-SNP Plan
Understanding LIS, SSBCI, and What Really Determines Your Drug Copays in 2026
If you’re on a Medicare Dual Special Needs Plan (D-SNP), you may be asking a frustrating question this year:
“Why am I suddenly paying for prescriptions that used to be $0?”
You’re not alone—and you didn’t do anything wrong.
What changed isn’t your health.
What changed is how prescription costs are determined.
Learn more about Medicare DSNP
The Real Problem: Benefits That Look the Same—but Aren’t
For years, many people on D-SNP plans had $0 prescription copays and generous extras like food and utility cards. It felt automatic.
In 2026, that changed.
Why?
Because two different programs that used to overlap are now clearly separated:
SSBCI (Special Supplemental Benefits for the Chronically Ill)
LIS (Low-Income Subsidy / Extra Help)
They serve very different purposes, and only one controls prescription drug costs.
What SSBCI Actually Does (and Does NOT Do)
SSBCI is tied to:
Verified chronic conditions
Medical documentation
Plan-specific eligibility rules
SSBCI is what allows plans to offer things like:
Food cards
Utility assistance
Transportation
Other non-medical support
SSBCI does NOT determine prescription copays.
If your food or utility card changed—or now requires additional documentation—that’s an SSBCI issue, not a prescription issue.
The Key Player for Prescriptions: LIS (Extra Help)
What Is LIS?
LIS (Low-Income Subsidy)—also called Extra Help—is a federal program administered through Social Security.
Its purpose is to lower what you pay for Medicare Part D prescriptions.
LIS determines:
Whether you have a drug deductible
Your copay amounts for generic vs. brand medications
Whether your costs are capped
Why Prescriptions Are No Longer Automatically $0 on D-SNP
In the past, many insurance companies used VBID-related programs to lower prescription costs—sometimes to $0—even beyond what LIS required.
With recent changes and the scaling back of VBID prescription relief, prescription costs are now determined strictly by LIS level, not by:
SSBCI eligibility
Chronic condition status
The D-SNP plan alone
Understanding LIS Levels (This Is Important)
There are three LIS levels, and Level 3 is the highest.
Important clarification:
The amounts shown for each LIS level are maximum allowed copays, not automatic charges.
That means:
If your LIS level shows a $12.65 brand-name copay
But your medication only costs $6
You pay $6, not $12.65
👉 LIS sets a ceiling, not a flat fee.
Low-Income Subsidy (LIS) Prescription Cost-Sharing - 2026
Important: The Amounts below represent the maximum copays based on LIS Level.
Members may pay less if the medication costs less than the amount listed.
What Many People Don’t Realize About 2026 Drug Costs
Even if you pay small copays throughout the year, Medicare added an important protection:
2026 Medicare Part D Maximum Out-of-Pocket: $2,100
Once that limit is reached:
Covered medications cost $0 for the rest of the year
More than just pharmacy copays count toward that limit
Manufacturer discounts and plan payments also apply
Because of this, many people with LIS:
Reach the cap early
Or never come close because their medications are low-cost
What If Someone Doesn’t Have LIS?
If a person does not have LIS:
They may face a drug deductible
Coinsurance instead of flat copays
Higher overall prescription costs
This is why LIS eligibility matters so much.
Most D-SNP Members Should Qualify for LIS
Here’s the good news:
Most people on a D-SNP plan should qualify for LIS.
However:
LIS enrollment isn’t always automatic
LIS levels can change over time
Some people have LIS and don’t know it
Others qualify but never applied
How We Help at Mere
This system is confusing—even for people who work in healthcare.
Our team helps by:
Verifying whether you currently have LIS
Confirming which LIS level you’re on
Explaining what your prescription costs should look like
Helping you apply for LIS if you’re eligible
Making sure SSBCI, LIS, and D-SNP benefits are aligned correctly
There is no cost and no obligation for this help.
The Bottom Line
Food & utility cards are tied to SSBCI
Prescription costs are determined by LIS
$0 drug copays are no longer automatic
LIS provides caps, protections, and predictability
Most D-SNP members qualify—but verification matters
If something feels off, it’s worth checking—not guessing.
Need Help Verifying Your LIS or Understanding Your Costs?
📞 Contact our office or
🌐 Visit www.merebenefits.com
Simply for your benefit.
