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.
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 our Plan.
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 a low income subsidy (LIS) 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 LIS Rider for those who Receive Extra Help Paying for their Prescription Drugs.
How do you know if you qualify for extra help?
If you aren’t getting extra help, you can see if you qualify by calling:
- 1-800-Medicare of TTY/TDD users call 1-877-486-2048 (24 hours a day/7 days a week),
- Your State Medicaid Office, or
- The Social Security Administration at 1-800-772-1213. TTY/TDD users should call 1-800-325-0778 between 7 a.m. and 7 p.m., Monday through Friday.
If you have any questions, please call Customer Service at 1-866-789-7747, (TTY/TDD: 1-866-264-4141) from 8 am to 8 pm Monday through Friday, and Saturday and Sunday from 8 am to 8 pm between October 15 and February 14 (Pacific Time).
Other Resources
- Medicare Plan Transition process information - You will leave the Soundpath Health website with this link
- Medicare Best Available Evidence (BAE) policy - You will leave the Soundpath Health website with this link
- Soundpath Health Appeals Document
Extra Help in 2012
| Your level of extra help | Monthly premium for Sound + Rx* | Monthly premium for Pinnacle + Rx* | Monthly premium for Charter + Rx* | Monthly premium for Apex + Rx* |
|---|---|---|---|---|
| 100% | $0 | $13.90 | $61.20 | $132.55 |
| 75% | $0 | $15.70 | $69.40 | $141.66 |
| 50% | $0 | $17.40 | $77.60 | $150.77 |
| 25% | $0 | $19.20 | $85.80 | $159.89 |
Note: *This does not include any Medicare Part B premium you may have to pay. Sound +Rx, Charter +Rx, Apex +Rx and Pinnacle +Rx premium includes coverage for both medical services and prescription drug coverage.
Extra Help in 2011
| Plan | Non- LIS | 100% | 75% | 50% | 25% |
|---|---|---|---|---|---|
| Sound + Rx | $0 | $0 | $0 | $0 | $0 |
| Charter + Rx | $79 | $62 | $66.20 | $70.50 | $74.70 |
| Apex + Rx | $152 | $116.70 | $125.50 | $134.30 | $143.20 |
| Apex King County + Rx | $162 | $126.70 | $135.50 | $144.30 | $153.20 |
| Summit + Rx | $190 | $154.70 | $163.50 | $172.30 | $181.20 |
Note: premiums listed are for both medical services and prescription drug benefits (MAPD plans only). Premiums listed do not include any Part B premium the member may have to pay.
The above income and resource amounts are for 2011 and will change in 2012. If you live in Alaska or Hawaii, or pay at least half of the living expenses of dependent family members, income limits are higher.
Page Last Updated: November 2, 2011
You may be able to get Extra Help to pay for your prescription drug premiums and costs. To see if you qualify for extra help, call: 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048, 24 hours a day/7 days a week; The Social Security Office at 1-800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday. TTY users should call 1-800-325-0778; or your State Medicaid Office.
H9302_Soundpath Health 2012 Website CMS Approved 10282011
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Important Disclaimers
Soundpath Health is a health plan with a Medicare contract. The benefit information provided herein is a brief summary, not a comprehensive description of benefits. For more information contact Soundpath Health. Benefits, formulary, pharmacy network, premium and/or co-payments/co-insurance may change on January 1, 2012. You must continue to pay your Medicare Part B premium. Limitations, copayments, and restrictions may apply. Individuals must have both Part A and Part B to enroll. You may be able to get Extra Help to pay for your prescription drug premiums and costs. To see if you qualify for extra help, call: 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048, 24 hours a day/7 days a week; The Social Security Office at 1-800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday. TTY users should call 1-800-325-0778; or your State Medicaid Office. Members may enroll in the plan only during specific times of the year. Contact Soundpath Health for more information. Medicare beneficiaries may enroll in Soundpath Health through the CMS Medicare Online Enrollment Center located at http://www.medicare.gov. *Members are 30 seconds or less away from speaking to a customer service representative based on 2010 annual internal telephone statistics.