Low Income Subsidy also called "Extra Help" for People with Limited Incomes

Extra Help for Prescription Drug Costs

The Federal government has a program called Extra Help (also called the Low Income Subsidy). This program helps people with limited incomes pay for their prescription drug costs with Medicare Part D.

You may be able to get Extra Help to lower your prescription drug premiums and copayments. To find out if you qualify for Extra Help, call:

• 1-800-MEDICARE (1-800-633-4227)
  TTY Users should call 1-877-486-2048,
  24 hours a day/7 days a week.
• Social Security Administration at 1-800-772-1213
  (TTY/TDD users call, 1-800-325-0778)
  between 7:00 a.m. and 7:00 p.m., Monday through Friday
• Contact your state Medicaid Office

If you qualify for Extra Help, your copayments for prescription drug costs as well as your monthly plan premium will be lower. Once you are enrolled in a Medicare Advantage Prescription Drug Plan (MAPD), this subsidy will be applied to your coverage and we will send you information on the lower amount for your monthly premium. At the pharmacy, you will be charged lower copayments for your prescription drugs. Note that Extra Help will not pay for your monthly Medicare Part B premium.

There are four different levels of Extra Help. Depending on which level you are eligible for, your monthly plan premium will vary. The four levels of Extra Help cover either, 100%, 75%, 50% or 25% of a portion of your monthly Medicare Part D plan premium. Extra Help does not always apply to the full amount of your Medicare Part D plan premium. Note that if you have a Medicare Advantage Prescription Drug Plan, your Medicare Part C Premium will not be lowered.

Remember: In order to use the Extra Help Program you must be enrolled in a PDP or MAPD plan. You can choose to enroll in a PDP or MAPD plan.

These charts show what you might expect to pay for your medications if you qualify for 100%, 75%, 50% or 25% Extra Help as a Fresenius Health Partners member.

Texas

Georgia

North Carolina

Tennessee

Using the Best Available Evidence Policy (BAE)

You can use the Best Available Evidence (BAE) policy when the information that your Medicare Prescription Drug Plan (PDP) or Medicare Advantage Prescription Drug Plan (MAPD) has on your Low Income Subsidy is not up to date. Because of data exchanges, the right information is not always with your pharmacist or your PDP or MAPD plan when you need it.

When this happens you can use the BAE to show that you qualify. Such evidence may be your award letter from the Social Security Administration, your Medicaid card or other proof that you were found eligible for Extra Help. When you give this information to your Medicare Prescription Drug plan, your plan will update your Low Income Subsidy information as soon as possible.

For more information on Low Income Subsidy and BAE, you may visit the BAE policy on the Medicare Web site (by clicking on this link you are leaving our Web site).

PDF files require the free Adobe Reader. If you do not have Adobe Reader, you may download it free by clicking the button on the left.