Medicare LI NET Program Offers Temporary Drug Coverage for Low Income Beneficiaries

The Limited Income Newly Eligible Transition (LI NET) Program provides temporary Medicare Part D prescription drug coverage for low income beneficiaries who are eligible for Medicare but have not yet enrolled in a Medicare Part D plan. Established on January 1, 2010, and made a permanent part of Medicare under the Consolidated Appropriations Act of 2021 effective in 2024, LI NET offers coverage for up to two months to bridge the gap before beneficiaries select and enroll in a Part D plan.

Medicare Part D plans are administered by private insurers and vary in premiums, deductibles, and coinsurance. LI NET is currently managed nationwide by Humana and features an open formulary that includes nearly all drugs covered under Part D plans, except those excluded or restricted by federal law. This allows beneficiaries unrestricted access to network pharmacies for their prescriptions during the transition period.

To qualify for LI NET, beneficiaries must be recognized as eligible due to low income and not be enrolled in a Medicare Part D plan. Enrollment begins on the first day of eligibility and lasts for two months. Retroactive coverage or reimbursements may be available for prescriptions filled prior to enrollment within certain dates. While LI NET does not require monthly premiums or deductibles, copayments may apply based on individual eligibility levels.

Pharmacists can verify LI NET eligibility through Medicare's system or appropriate documentation and submit claims directly to the program. The open formulary approach and no restrictions on pharmacy networks provide flexibility and immediate access to necessary medications. This temporary coverage supports beneficiaries during the plan selection process, ensuring continuity of prescription drug coverage and helping to mitigate gaps in access to medications.

The program positively impacts the Medicare pharmaceutical market by reducing coverage delays for vulnerable low income populations and simplifying the initial transition into Part D coverage. It also offers insurers and providers a streamlined mechanism for serving newly eligible beneficiaries during enrollment periods. Overall, LI NET enhances access and affordability in prescription drug coverage for low income Medicare enrollees during a critical transition phase.