Medicare prescription drug coverage options in a nutshell. (Video, 3:43)Open video transcript
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.
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.
- $1.20 for generics and brands treated as generics; $3.70 for brand-name drugs.
- $3.30 for generics and brands treated as generics; $8.25 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.
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 0||Option 1||Option 2||Option 3|
|Your level of Extra Help||HAP Senior Plus Tiered Access (HMO)
||HAP Senior Plus (PPO)
|Option 0||Option 1||Option 2|
|LIS Category||LIS Drug Copay
|LIS Drug Copay
All Other Drugs
|4||$82.00 deductible and 15% or copay of the benefit, whichever is less.||$82.00 deductible and 15% or copay of the benefit, whichever is less.|
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.