Medica Complete Solution^SM with Prescription Drug Coverage

2009 Low Income Subsidy (LIS) Monthly Premium

Information Supplemental Medicare Coverage

If you get extra help from Medicare to help pay for your Medicare prescription drug plan costs, your monthly plan premium will be lower than what it would be if you did not get extra help from Medicare. The amount of extra help you get will determine your total monthly plan premium as a member of Medica Complete Solution with Prescription Drug Coverage.

This table shows you what your monthly plan premium will be if you get extra help. The premium includes coverage for both medical services and prescription drug coverage.

Your Level of Extra Help	Medica Complete Solution with Rx MN Members Monthly Premium *
100%	$49.21
75%	$57.51
50%	$65.81
25%	$74.10

*This does not include any Medicare Part B premium you may have to pay.


Best Available Evidence (BAE) Policy

If your current Medicare eligibility information is incorrect, Medicare requires health plans to verify your eligibility by other means. If you believe you are eligible for the Low Income Subsidy, but your current information does not reflect that eligibility, please use the resources on the following website to help you qualify:
Visit the Centers for Medicare & Medicaid Services Web site.  

You may also call:

If you have any questions, please call Medica Customer Service at t 952-992-2345 or 1-800-906-5432, (TTY/TDD: 952-992-3650 or 1-800-234-8819) from 8 a.m. – 8 p.m., CST 7 days a week.


Medicare Resources
Community Meetings
Coverage Determination (exception), appear and grievance questions?
How to Contact Us



CMS File #H2409, H2450, H2458, H7526_2024 (12/2008)