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Help paying for prescriptions

Medicare Part D subsidy lowers copays and premiums for those who qualify

If you have limited income, you may qualify for a Medicare Part D subsidy known as Extra Help. If you qualify and enroll in one of our Medicare Advantage plans with prescription drug coverage, you may pay less for copays and premiums.

Find a Medicare plan with Part D prescription drug coverage.

How does Extra Help affect what I pay for prescription drugs?

If you qualify for Extra Help, your costs for prescriptions drugs will be one of the following, depending on the amount of Extra Help for which you qualify:

  • $0 for generics and brands treated as generics; $0 for brand-name drugs.
  • $1.25 for generics and brands treated as generics; $3.70 for brand-name drugs.
  • $3.35 for generics and brands treated as generics; $8.35 for brand-name drugs.
  • 15 percent coinsurance or the Plan Option copay, whichever is less, for all drugs. At this level of Extra Help, if your plan includes an upfront prescription drug deductible, you must first pay the plan deductible. The maximum deductible you’ll pay in a year is $82.

In addition, there is no coverage gap (donut hole) for people who qualify for Extra Help.

Medicare Part D explained

Medicare prescription drug coverage options in a nutshell. (Video, 3:43)

Open video transcript

Can I get Extra Help with premium costs?

If you qualify for Extra Help, Medicare may pay some or all of your Part D premium. Extra Help is only for Part D prescription costs, not for medical benefits. You must continue to pay Part B premiums.

Your level of Extra Help HAP Senior Plus (HMO)
HAP Senior Plus (HMO-POS)
Option 1 Option 2 Option 3
100% $0 $0 $26.00 $55.40
75% $0 $0 $19.50 $47.10
50% $0 $0 $13.00 $38.70
25% $0 $0 $6.50 $30.40

Your level of Extra Help HAP Senior Plus Tiered Access (HMO)
HAP Senior Plus (PPO)
Option 1 Option 2 Option 3
100% $21.00 $15.00 $51.40  $57.80
75% $15.80 $11.30 $43.10 $49.50
50% $10.50 $7.50 $34.70  $41.10
25% $5.30 $3.80 $26.40  32.80

LIS Category LIS Drug Copay
Generic Preferred
LIS Drug Copay
All Other Drugs
1 $3.30 $8.25
2 $1.20 $3.70
3 $0.00 $0.00
4 $83.00 deductible and 15% or copay of the benefit, whichever is less. $83.00 deductible and 15% or copay of the benefit, whichever is less.

Download a copy of this chart (PDF).

You may receive (or may have received) a letter from Medicare or the Social Security Administration about your eligibility for Extra Help. Read this information carefully.

How do I qualify for Extra Help?

To see if you qualify for Extra Help, call:

  • Medicare: (800) 633-4227, 24 hours a day, seven days a week. TTY/TDD users should call (877) 486-2048.
  • Social Security Administration: (800) 772-1213 between 7 a.m. and 8 p.m. Monday through Friday.
  • The Michigan Medicaid office.

How does HAP know the level of Extra Help I’m getting?

We use the most current information available to us. This is known as the “Best Available Evidence.” When our information or your level of Extra Help changes, we’ll make appropriate adjustments to your prescription drug expenses.

Learn more about Best Available Evidence.

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Copyright © 2017 HAP
2017 Health Alliance Plan of Michigan
Y0076_ALL 2018067 2018 WEB 10.1
Pending CMS Approval
Last Update 10/1/2017

HAP Senior Plus HMO, HMO-POS, and PPO are health plans with a Medicare contract. Enrollment in these plans depends on contract renewal. HAP Senior Plus PPO is a product of Alliance Health and Life Insurance Company, a wholly owned subsidiary of HAP. Alliance Medicare Supplement is a product of Alliance Health and Life Insurance Company, a wholly owned subsidiary of HAP.

This information is not a complete description of benefits. Contact the plan for more information. Limitations, copayments, and restrictions may apply. Benefits, premiums, and/or copayments/coinsurance may change on January 1 of each year. You must continue to pay your Medicare Part B premium. The formulary, pharmacy network, and/or provider network may change at any time. You will receive notice when necessary.

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  • HAP Medicare Sales:

    (877) 547-5186 (TTY:711)

  • (800) 868-3153 TTY: 711

    HAP Senior Plus®

    (800) 801-1770 TTY: 711

  • HAP Senior Plus®(PPO)

    (888) 658-2536 TTY: 711

  • Alliance Medicare Supplement:

    (800) 873-7526 TTY: 711