- Prescription Drugs
- Extra Help Paying for Prescription Medications
- Medication Therapy Management Program
- PSHP Pharmacies
Extra Help Paying for Prescription Medications
What extra help is available?
Medicare provides "extra help" to pay prescription drug costs for people who have limited income and resources. Resources include your savings and stocks, but not your home or car. If you qualify, you will get help paying for your Medicare drug plan's monthly premium, yearly deductible, and prescription co-payments. If you qualify, this extra help will count toward your out-of-pocket costs.
| Plan | Non- LIS | 100% | 75% | 50% | 25% |
|---|---|---|---|---|---|
| Partners Charter + Rx | $70 | $55.10 | $55.10 | $55.10 | $62.02 |
| Partners Apex + Rx | $150 | $118.06 | $126.05 | $134.03 | $142.02 |
| Partners Apex King County + Rx | $160 | $128.06 | $136.05 | $144.03 | $152.02 |
| Partners Summit + Rx | $180 | $148.06 | $156.05 | $164.03 | $172.02 |
Note: premiums listed are for both medical services and prescirption drug benefits (MAPD plans only). Premiums listed do not include any Part B premium the member may have to pay.
Do you qualify for extra help?
People with limited income and resources may qualify for extra help one of two ways. The amount of extra help you get will depend on your income and resources.
1. You automatically qualify for extra help and don't need to apply. If you have full coverage from a state Medicaid program, get help from Medicaid paying your Medicare premiums (belong to a Medicare Savings Program), or get Supplemental Security Income benefits, you automatically qualify for extra help and do not have to apply for it. Medicare mails letters monthly to people who automatically qualify for extra help.
2. You apply and qualify. You may qualify if your yearly income in 2007 is less than $15,315 (single with no dependents) or $20,535 (married and living with your spouse with no dependents), and your resources are less than $11,710 (single) or $23,410 (married and living with your spouse). Resources include your savings and stocks but not your home or car. If you think you may qualify, call Social Security at 1-800-772-1213, visit www.socialsecurity.gov on the web, or apply at your State Medical Assistance (Medicaid) office. TTY users should call 1-800-325-0778. After you apply, you will get a letter in the mail letting you know if you qualify and what you need to do next.
The above income and resource amounts are for 2007 and will change in 2008. If you live in Alaska or Hawaii, or pay at least half of the living expenses of dependent family members, income limits are higher.
How do costs change when you qualify for extra help?
The extra help you get from Medicare will help you pay for your Medicare drug plan's monthly premium, yearly deductible, and prescription co-payments. The amount of extra help you get is based on your income and resources. If you qualify for extra help, we will send you by mail an "Evidence of Coverage Rider for those who Receive Extra Help Paying for their Prescription Drugs" that explains your costs as a member of our Plan. If the amount of your extra help changes during the year, we will also mail you an updated "Evidence of Coverage Rider for those who Receive Extra Help Paying for their Prescription Drugs".
Medicare Plan Transition process information - You will leave the PSHP site with this link
Medicare Best Available Evidence (BAE) policy - You will leave the PSHP site with this link