If you qualify for extra help, you’ll get a Low Income Subsidy (LIS) rider. This means that you will get help paying your monthly premium and prescription drug cost-sharing. As a member of our Plan, you will get the same coverage as someone who is not getting Extra Help. Your membership in our Plan will not be affected by the Extra Help. This also means that you must follow all the rules and procedures in the Member Handbook.

We offer coverage of some supplemental prescription drugs not normally covered in a Medicare Prescription Drug Plan. These drugs are covered through Medical Assistance (Medicaid). Please see the chart below:

Level of Extra Help*

Level  Your monthly plan premium is Your yearly deductible is Your cost-sharing amount for generic/preferred multi-source drugs is no more than Your cost-sharing amount for all other drugs is no more than
Level 3 $0* $0 $0
(each prescription)
$0
(each prescription)
Level 2 $0* $0 $1.30
(each prescription)
$3.90
(each prescription)
Level 1 $0* $0 $3.60
(each prescription)
$8.95
(each prescription)

These amounts are effective January 1, 2020.

Once the amount both you and Medicare pay (as the Extra Help) reaches $6,350 in a year, your copayment amount(s) will go down to $0 per prescription