For Members with “Extra Help”
People with limited incomes may qualify for “Extra Help” to pay for their prescription drug costs. If you qualify, Medicare could pay for up to seventy-five (75) percent or more of your drug costs including monthly prescription drug premiums, annual deductibles, and co-insurance. Additionally, those who qualify will not be subject to the coverage gap or a late enrollment penalty. Many people are eligible for these savings and don’t even know it. For more information about this Extra Help, contact your local Social Security office or call 1-800-MEDICARE (1-800-633-4227), 24 hours per day, 7 days per week. TTY users should call 1-877-486-2048.
Sometimes, the information PHP (HMO SNP) receives from Medicare about members’ “Extra Help” status may not be up to date or accurate. “Extra Help” is also known as low income subsidy (LIS). When this happens, PHP will accept documentation, also known as “best available evidence,” from members or members’ representatives that shows an updated “Extra Help” status. If the documents meet Medicare’s requirements, the plan will grant the member “Extra Help,” which will result in lower cost sharing for covered prescription drugs. The plan will also tell Medicare about the change in “Extra Help” status so Medicare can verify the change. Medicare has rules about “best available evidence” that the plan must follow. Learn more about Medicare’s “Best Available Evidence” Policy. (By clicking this link, you will be taken to the Centers for Medicare and Medicaid Services website.)
If you believe that you should receive lower-costing (the amount you pay) for your covered prescription drugs than what you are being charged at a network pharmacy, please contact Pharmacy Benefit Customer Service as soon as possible.
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