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Legacy Health and OHSU opt to remain separate, foregoing merger plans The proposed merger of Legacy Health and Oregon Health & Science University will not move forward.

Medicare’s Extra Help program, officially known as the Low-Income Subsidy (LIS), is a federal program designed to assist eligible Medicare beneficiaries with limited income and resources in paying for prescription drug costs under Medicare Part D. Here’s a breakdown of what it entails, how it works, and who qualifies:
What It Covers
The Extra Help program helps cover:
• Premiums: Reduces or eliminates the monthly premium for a Medicare Part D prescription drug plan.
• Deductibles: Lowers or removes the annual deductible.
• Copayments/Coinsurance: Significantly reduces out-of-pocket costs for covered medications, often to a small fixed amount (e.g., a few dollars per prescription).
• Coverage Gap: Provides assistance even during the “donut hole” (a gap in Part D coverage where beneficiaries once paid full price), though recent legislative changes, like the Inflation Reduction Act of 2022, have begun phasing out this gap entirely by 2025.
In 2025, with the donut hole closed, Extra Help beneficiaries continue to benefit from low or no-cost prescriptions year-round, depending on their income level.
Eligibility
To qualify for Extra Help, individuals must:
• Be enrolled in Medicare (Part A or Part 😎.
• Have limited income and resources:
◦ Income: For 2025, the income limit is typically around 150% of the Federal Poverty Level (FPL). For example, in 2024, this was roughly $20,385 for an individual or $27,465 for a married couple (adjusted annually, so 2025 figures may be slightly higher).
◦ Resources: Assets like savings or investments must be below a certain threshold, e.g., $17,220 for an individual or $34,360 for a couple in 2024 (excluding your home, car, and personal belongings). These limits are also adjusted yearly.
• Live in one of the 50 states or Washington, D.C.
There are two levels of assistance:
• Full Subsidy: For those with the lowest incomes (e.g., below 135% FPL) and who qualify for Medicaid or certain Medicare Savings Programs.
• Partial Subsidy: For those with slightly higher incomes (up to 150% FPL), offering reduced but still significant help.
How to Apply
• Automatic Enrollment: Some people are automatically enrolled if they receive Medicaid, Supplemental Security Income (SSI), or a Medicare Savings Program.
• Manual Application: Others can apply through the Social Security Administration (SSA) online at ssa.gov, by phone (1-800-772-1213), or in person. The process is straightforward and doesn’t require extensive documentation—SSA verifies income and resources with the IRS.
Benefits in Practice
For someone with Extra Help, a prescription that might cost $50 out-of-pocket without assistance could drop to $4 or less for generics and $10 or less for brand-name drugs (2024 figures; 2025 copays may adjust slightly). This can be a lifeline for seniors or disabled individuals managing chronic conditions like diabetes or heart disease.
Recent Changes
The Inflation Reduction Act has enhanced Medicare Part D overall, capping out-of-pocket drug costs at $2,000 annually starting in 2025 for all beneficiaries. For Extra Help recipients, costs remain even lower, often near zero, making it one of the most generous drug assistance programs available.
Challenges
• Awareness: Many eligible people don’t know about it or assume they won’t qualify.
• Complexity: Navigating Medicare Part D plans to maximize Extra Help benefits can be tricky, as not all plans align perfectly with an individual’s medication needs.
• Annual Changes: Beneficiaries must sometimes switch plans yearly to keep costs low, as formularies and premiums shift.

The United States Social Security Administration | SSA Official website of the U.S. Social Security Administration.

Latest on UHC and OHSU negotiations:

UnitedHealthcare Changes at OHSU Starting April 1, 2025, OHSU, Adventist Health Portland and Hillsboro Medical Center may no longer be in-network with UnitedHealthcare (United Healthcare, UHC).

Medicare Part B is one of the four main components of the Medicare program in the United States, designed to provide health insurance primarily for outpatient services. It’s available to Americans aged 65 and older, as well as certain younger individuals with qualifying disabilities or specific medical conditions, such as End-Stage Renal Disease. Unlike Medicare Part A, which covers inpatient hospital care and is premium-free for most people, Part B is optional and requires a monthly premium.
What Does Medicare Part B Cover?
Medicare Part B focuses on a variety of outpatient and preventive services, including:
• Doctor Visits: Appointments with primary care physicians, specialists, and other healthcare providers.
• Preventive Services: Many services are covered at no cost, such as annual wellness visits, screenings (e.g., for cancer, diabetes, or heart disease), and vaccines (e.g., flu shots).
• Durable Medical Equipment (DME): Medically necessary items like wheelchairs, walkers, and oxygen equipment.
• Outpatient Care: Services such as lab tests, X-rays, outpatient surgeries, and emergency room visits.
• Mental Health Services: Outpatient therapy, counseling, and certain treatments for mental health conditions.
• Ambulance Services: Transportation to medical facilities when medically necessary.
• Certain Prescription Drugs: Drugs administered in a doctor’s office (e.g., chemotherapy or injections), but not most self-administered medications, which are typically covered under Medicare Part D.
Costs Associated with Medicare Part B
Part B involves several out-of-pocket costs:
• Premiums: In 2024, the standard monthly premium is $174.70. However, higher-income beneficiaries may pay more due to the Income-Related Monthly Adjustment Amount (IRMAA), based on their income level.
• Deductible: There’s an annual deductible of $240 in 2024. You pay this amount out-of-pocket before Medicare begins covering Part B services.
• Coinsurance: After meeting the deductible, you typically pay 20% of the Medicare-approved amount for most services. For example, if a doctor’s visit costs $100, you’d pay $20, and Medicare would cover the remaining $80.
Enrollment and Eligibility
• Who is Eligible?: You qualify for Part B if you’re 65 or older, or under 65 with a qualifying disability or condition.
• Initial Enrollment Period (IEP): This is a 7-month window starting three months before your 65th birthday and ending three months after. Enrolling during this period helps you avoid penalties.
• Late Enrollment Penalty: If you delay signing up for Part B when first eligible and lack other creditable coverage (e.g., employer-sponsored insurance), your premium may increase permanently by 10% for each full year you could have enrolled but didn’t.
How Part B Works with Other Insurance
If you have other health insurance, like through an employer, you might delay enrolling in Part B without penalty, provided that insurance is considered creditable. However, you should understand the rules for coordination of benefits and timing to avoid coverage gaps or penalties.
Summary
Medicare Part B is a vital part of Medicare that covers outpatient medical services, preventive care, and certain equipment. While it comes with costs like premiums, deductibles, and coinsurance, it provides essential healthcare coverage. Enrollment decisions should be made thoughtfully, considering your health needs, finances, and any other insurance you may have.