Help With Medication Costs
Low-Income Subsidy — Medicare Extra Help Program
Extra Help is a federal program that helps pay for some to most of the out-of-pocket costs of Medicare prescription drug coverage. It is also known as the Part D Low-Income Subsidy (LIS). Medicare beneficiaries receiving the low-income subsidy (LIS) get assistance in paying for their Part D monthly premium, annual deductible, coinsurance, and copayments. Because you are receiving Medical Assistance (Medicaid), you qualify for and are getting "Extra Help" from Medicare to pay for your prescription drug plan costs. You do not need to do anything further to get this "Extra Help."
Best Available Evidence
If you lose your LIS during the year or if you believe that you are paying an incorrect cost-sharing amount when you get your prescription at a pharmacy, our plan has established a process that allows you to either request assistance in obtaining evidence of your proper copayment level, or, if you already have the evidence, to provide this evidence to us.
Please contact Member Services to request assistance or to provide one of the documents listed below to establish your correct copay level. Please note that any document listed below must show that you were eligible for Medical Assistance (Medicaid) during a month after June of the previous year:
- A copy of your Medical Assistance (ACCESS) card which includes your name, eligibility date and status level;
- A report of contact including the date a verification call was made to the Office of Medical Assistance Programs (Medicaid), and the name, title and telephone number of the state staff person who verified the Medical Assistance (Medicaid) status;
- A copy of a state document that confirms active Medical Assistance (Medicaid) status;
- A print out from the State electronic enrollment file showing the Medical Assistance (Medicaid) status;
- A screen print from the Medical Assistance (Medicaid) systems showing Medical Assistance (Medicaid) status;
- Other documentation provided by the State showing Medical Assistance (Medicaid) status;
- A Supplemental Security Income (SSI) Notice of Award with an effective date; or
- An "Important Information" letter from the Social Security Administration (SSA) confirming that you are "...automatically eligible for extra help..."
If you are a member who is institutionalized, please provide one or more of the following:
- A remittance from a long term care facility showing Medical Assistance (Medicaid) payment for a full calendar month;
- A copy of a state document that confirms Medical Assistance (Medicaid) payment to a long term care facility for a full calendar month on your behalf;
- A screen print from the Medical Assistance (Medicaid) systems showing your institutional status based on at least a full calendar month's stay for Medical Assistance (Medicaid) payment purposes.
When we receive the evidence showing your copayment level, we will update our system so that you can pay the correct copayment when you get your next prescription at the pharmacy. If you overpay your copayment, we will reimburse you. Either we will forward a check to you in the amount of your overpayment or we will offset future copayments.
If the pharmacy hasn't collected a copayment from you and is carrying your copayment as a debt owed by you, we may make the payment directly to the pharmacy. If a state paid on your behalf, we may make payment directly to the state. Please contact Member Services if you have questions.