Medicare LI-NET, short for the Limited Income Newly Eligible Transition program, is temporary prescription drug coverage for low-income Medicare beneficiaries who qualify for Extra Help but aren’t yet enrolled in a Part D plan. It pays for any Part D-covered drug at any Medicare-participating pharmacy, with copayments ranging from $0 to $12.65 in 2026 depending on your income and living situation. It exists to keep people from going without medication during the gap between qualifying for help and getting a permanent plan.
Who Qualifies
LI-NET covers Medicare beneficiaries who qualify for the Part D Low-Income Subsidy (commonly called Extra Help) but have not yet enrolled in a Part D drug plan, or who have enrolled but whose coverage has not yet started.1Office of the Law Revision Counsel. 42 USC 1395w-114 – Premium and Cost-Sharing Subsidies for Low-Income Individuals That second situation matters more than people realize. If you signed up during open enrollment but your start date hasn’t arrived, LI-NET can bridge the gap.
Four groups can be covered, and the retroactive reach differs sharply between them:2Centers for Medicare & Medicaid Services. Medicare LI NET Program Partner Tip Sheet
- Full-benefit dual eligibles (people with both Medicare and Medicaid): covered retroactively for up to 36 months.
- Supplemental Security Income (SSI) recipients: covered retroactively for up to 36 months.
- Extra Help recipients who don’t fall into the two categories above: covered at the pharmacy counter and retroactively for up to 30 days.
- Medicare Savings Program participants (QMB, SLMB, or QI beneficiaries): covered at the pharmacy counter and retroactively for up to 30 days.
The difference is money in your pocket. A dual eligible who paid cash for prescriptions 18 months ago can be reimbursed. Someone who qualifies through Extra Help alone can only reach back 30 days.
Income and Resource Limits for 2026
Qualifying for Extra Help, and by extension LI-NET, generally requires income no higher than 150% of the federal poverty level. For 2026 that is $23,940 for an individual or $32,460 for a married couple.3Medicare.gov. Help with Drug Costs Partial subsidy amounts may apply if your income sits somewhat higher.
Resources also count. The 2026 limit is $18,090 for an individual and $36,100 for a married couple.3Medicare.gov. Help with Drug Costs Countable resources include bank accounts, stocks, bonds, and real estate other than your home. They exclude the home you live in, one car, personal belongings, and life insurance with a face value of $1,500 or less.
How You Get Enrolled
There is no LI-NET application form. You get in one of two ways.
The first is automatic. CMS matches Medicare records against state Medicaid data and Social Security records. When someone shows up as a full-benefit dual eligible or SSI recipient without Part D coverage, LI-NET enrollment is triggered in the background and can reach back as far as 36 months.4Centers for Medicare & Medicaid Services. Medicare Limited Income Newly Eligible Transition Program
The second is at the pharmacy counter. When you arrive needing medication and the pharmacist sees that you likely qualify, the pharmacist can process a claim that enrolls you on the spot.5eCFR. 42 CFR 423.2504 – LI NET Eligibility and Enrollment The rules also allow an “immediate need” pathway: if you state that you’re eligible for the subsidy and need your prescription now, but your eligibility can’t be verified electronically at that moment, the pharmacist can still process the claim.
What LI-NET Covers
Federal law requires LI-NET to operate under an open formulary, giving you access to every drug that Medicare Part D covers.1Office of the Law Revision Counsel. 42 USC 1395w-114 – Premium and Cost-Sharing Subsidies for Low-Income Individuals There is no restricted drug list and no pharmacy network. Any pharmacy in good standing that accepts Medicare can bill LI-NET. Permanent Part D plans, by contrast, keep their own formularies that may or may not include a given medication.
LI-NET still cannot pay for drug categories that Part D itself excludes by law:
- Weight loss or weight gain drugs, though medications for physical wasting from AIDS or cancer may be covered
- Fertility drugs
- Cosmetic drugs and hair growth products; treatments for conditions like psoriasis or acne are not considered cosmetic
- Over-the-counter medications
- Erectile dysfunction drugs
- Prescription vitamins and minerals, other than prenatal vitamins and fluoride preparations
If a doctor prescribes a drug for a use the FDA has not approved, coverage depends on whether the use appears in Medicare-approved drug reference guides. Cancer medications get somewhat more flexibility here than other drugs.
What You Pay in 2026
LI-NET has no monthly premium and no annual deductible. You pay a small copayment at the pharmacy, and the amount depends on your income level and your living situation:6Centers for Medicare & Medicaid Services. Calendar Year 2026 Resource and Cost-Sharing Limits for Low-Income Subsidy
- If you’re institutionalized or receiving Medicaid-funded home and community-based services: $0 for both generics and brand-name drugs.
- If your income is at or below 100% of the federal poverty level: $1.60 for generics, $4.90 for brand-name drugs.
- If your income is between 100% and 150% of the federal poverty level: $5.10 for generics, $12.65 for brands.
Non-dual-eligible beneficiaries who qualify through a Medicare Savings Program or SSI alone pay $5.10 for generics and $12.65 for brands.6Centers for Medicare & Medicaid Services. Calendar Year 2026 Resource and Cost-Sharing Limits for Low-Income Subsidy Once your out-of-pocket spending reaches $2,100 in a calendar year, copayments drop to $0 for the rest of that year.
If you live in a nursing home or receive Medicaid home and community-based services, a pharmacy cannot charge you anything for covered Part D drugs. The $0 copayment is absolute. If a pharmacy tries to collect payment, point them to your Medicaid or LI-NET coverage.
What to Bring to the Pharmacy
If your LI-NET eligibility has not been confirmed electronically yet, you’ll need to show proof. Acceptable documents include:5eCFR. 42 CFR 423.2504 – LI NET Eligibility and Enrollment
- A Medicaid card showing your name and eligibility date
- A letter from your state or the Social Security Administration confirming Extra Help status
- A state document confirming active Medicaid status
Keep these somewhere you can grab quickly until your permanent Part D card arrives. Humana administers LI-NET on behalf of CMS, and pharmacy staff unfamiliar with the program may need a nudge to run the claim through the right billing route.4Centers for Medicare & Medicaid Services. Medicare Limited Income Newly Eligible Transition Program
Getting Money Back for Drugs You Already Paid For
If you paid out of pocket for prescriptions during a period when you were eligible for LI-NET, you can ask for reimbursement. You submit a direct reimbursement request form to Humana along with your pharmacy receipts.7eCFR. 42 CFR 423.2504 – LI NET Eligibility and Enrollment Including proof of your Extra Help or Medicaid status is optional under the regulations but helps move things along.
You have up to 36 months from the date the prescription was filled to send in a reimbursement request.8Humana. Direct Reimbursement Request for the LI NET Program Once Humana has your completed form, the rules require a coverage decision within 14 calendar days.7eCFR. 42 CFR 423.2504 – LI NET Eligibility and Enrollment
This route matters most for full-benefit dual eligibles and SSI recipients, whose retroactive coverage stretches up to 36 months. If you qualify through Extra Help alone, retroactive reimbursement is capped at 30 days before your enrollment date.
What Happens When LI-NET Ends
LI-NET enrollment typically lasts two months.5eCFR. 42 CFR 423.2504 – LI NET Eligibility and Enrollment During that window, CMS auto-assigns you to a permanent standalone Part D plan. You’ll get a letter with the plan name, the start date, and your rights as a beneficiary. When permanent coverage begins, LI-NET ends.
The plan CMS picks may or may not suit your medications. Permanent Part D plans keep restricted formularies, and some of your current prescriptions may not be covered or may need prior authorization. Read the plan’s formulary and pharmacy list before assuming everything carries over.
If the assignment doesn’t work, you have room to change it. Beneficiaries who have Medicaid or Extra Help can switch Medicare drug plans once per calendar month, with the change taking effect the first day of the following month.9Medicare.gov. Special Enrollment Periods Most Medicare enrollees can only change plans during fall open enrollment. Use the monthly window to compare plans on Medicare.gov and pick one whose formulary covers your drugs at the lowest copayment tier.