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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.

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.

For 2020 plans

  • $0 for generics and brands treated as generics; $0 for brand-name drugs.
  • $1.30 for generics and brands treated as generics; $3.90 for brand-name drugs.
  • $3.60 for generics and brands treated as generics; $8.95 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 $89.

For 2019 plans

  • $0 for generics and brands treated as generics; $0 for brand-name drugs.
  • $1.25 for generics and brands treated as generics; $3.80 for brand-name drugs.
  • $3.40 for generics and brands treated as generics; $8.50 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 $83.

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.

2020

Your level of Extra Help HAP Senior Plus (HMO)
HAP Senior Plus (HMO-POS)
Option 1 Option 2
100% $0 $0 $20.80
75% $0 $6.60 $28.40
50% $0 $13.20 $35.90
25% $0 $19.80 $43.50
Your level of Extra Help HAP Senior Plus
Henry Ford Tiered Access (HMO)
HAP Senior Plus (PPO)
Option 1 Option 2 Option 3 Option 4
100% $0.20 $0 $3.20  $27.80 $28.80 
75% $7.80 $0 $10.80  $35.40 $36.40 
50% $15.30 $0 $18.30 $42.90   $43.90
25% $22.90 $0 $25.90  $50.50  $51.50
Your level of Extra Help HAP Primary Choice Medicare (HMO) HAP Choice Medicare HMO
 Option 1  Option 2
100% $0  $0  $0
75%
$0
 $0  $5.10
50%
$0
 $0  $10.20
25%
$0
 $0  $15.30
Your level of Extra Help
HAP Empowered Duals (HMO SNP)
100% $0
75%
$7.60
50%
$15.10
25%
$22.70
LIS Category LIS Drug Copay
Generic Preferred
LIS Drug Copay
All Other Drugs
1 $3.60 $8.95
2 $1.30 $3.90
3 $0 $0
4 $0- 89 deductible may apply, based on your prescription drug coverage; and 15 percent coinsurance or copay of the benefit, whichever is less. $0- 89 deductible may apply, based on your prescription drug coverage; and 15 percent coinsurance or copay of the benefit, whichever is less.

Download a copy of the 2020 chart (PDF).

2019

Your level of Extra Help HAP Senior Plus (HMO)
HAP Senior Plus (HMO-POS)
Option 1 Option 2 Option 3
100% $0 $0 $0 $2.10
75% $0 $0 $6 $10.30
50% $0 $0 $12 $18.50
25% $0 $0 $18 $26.80
Your level of Extra Help HAP Senior Plus
Henry Ford Tiered Access (HMO)
HAP Senior Plus (PPO)
Option 1 Option 2 Option 3 Option 4
100% $0 $0 $30.10  $56.20 $49.40 
75% $4 $3.70 $38.40 $64.50
 $57.60
50% $8 $7.50 $46.80  $72.90  $65.80
25% $12 $11.20 $55.10  $81.20 $74.10 
Your level of Extra Help HAP Primary Choice Medicare (HMO) 
100% $0
75% $0
50% $0
25% $0
LIS Category LIS Drug Copay
Generic Preferred
LIS Drug Copay
All Other Drugs
1 $3.35 $8.35
2 $1.25 $3.70
3 $0 $0
4 $0 deductible may apply, based on your prescription drug coverage; and 15 percent coinsurance or copay of the benefit, whichever is less. $0 deductible may apply, based on your prescription drug coverage; and 15 percent coinsurance or copay of the benefit, whichever is less.

Download a copy of the 2019 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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* You must continue to pay your Medicare Part B premium. If you have a late enrollment penalty, it will still apply.


Copyright © 2019 HAP
2019 Health Alliance Plan of Michigan
Y0076_ALL 2020 HAP Website_M
CMS Accepted 9/29/2019

 Last Updated 9/26/2019

Health Alliance Plan (HAP) has HMO, HMO-POS, PPO plans with Medicare contracts. HAP Empowered Duals (HMO SNP) is a Medicare health plan with a Medicare contract and a contract with the Michigan Medicaid Program. Enrollment depends on contract renewals.

This information is not a complete description of benefits. For more information call Medicare Michigan customer service at (800) 868-9885 (TTY: 711) 8 a.m. to 8 p.m., seven days a week (Oct. 1 – March 31) / 8 a.m. to 8 p.m., Monday through Friday (April 1 - Sept. 30).


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Contact us

  • HAP Medicare Sales:

    (800) 868-9885 (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)