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 prescription 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.
- $1.60 for generics and brands treated as generics; $4.90 for brand-name drugs.
- $5.10 for generics and brands treated as generics; $12.65 for brand-name drugs.
In addition, there is no coverage gap 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.
HMO Plan Name | Your Premium After Extra Help |
|---|---|
HAP Senior Plus Henry Ford Tiered Access (HMO) | $86.20 |
HAP Medicare Superior (HMO) | $0 |
Henry Ford Select (HMO) | $0 |
HAP Senior Plus (HMO-POS) | $96.20 |
HAP Medicare Complete Duals (HMO D-SNP) | $0 |
HAP Medicare Diabetes and Heart (HMO C-SNP) | $0 |
HAP Medicare Connect (HMO) | $0 |
PPO Plan Name | Your Premium After Extra Help |
|---|---|
HAP Medicare Explore (PPO) | $0 |
HAP Medicare Prime (PPO) | $0 |
HAP Member Assist (PPO) | $0 |
HAP Senior Plus (PPO) | $156.20 |
HAP Medicare Complete Assist (PPO D-SNP) | $0 |
LIS Copay Level | LIS Drug Copay Generic | LIS Drug Copay All Other Drugs |
|---|---|---|
1 | $5.10 | $12.65 |
2 | $1.60 | $4.90 |
3 | $0 | $0 |
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 (TTY: 711) between 7 a.m. and 8 p.m. Monday through Friday.
- Michigan Healthcare Help Line: (855) 789-5610. TTY users should call (866) 501-5656.
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 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 on the Centers for Medicare and Medicaid Services website.
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Health Alliance Plan (HAP) has HMO, HMO C-SNP, HMO-POS, and PPO plans with Medicare contracts. HAP Medicare Complete Duals (HMO D-SNP), HAP Medicare Complete Assist (PPO D-SNP), and HAP CareSourceTM MI Coordinated Health (HMO D-SNP) are Medicare health plans with a Medicare contract and a contract with the Michigan Medicaid Program that provides benefits of both programs to enrollees. Enrollment depends on contract renewals.