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LIS Premium Summary Chart
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Monthly Plan Premium for People who get Extra
Help from Medicare to Help Pay for their Prescription Drug Costs
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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.
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This table shows you what your monthly plan premium will be if you get extra help.
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Your level of extra help
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Monthly Premium
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100%
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$0
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75%
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$0
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50%
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$0
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25%
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$0
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*This does not include any Medicare Part B premium you may have to pay.
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If you aren’t getting extra help, you can see if you qualify by calling:
- 1-800-MEDICARE (1-800-633-4227). TTY/TDD users call 1-877-486-2048, 24 hours a day/7
days a week,
- The Social Security Administration at 1-800-772-1213 between 7am and 7pm, Monday
through Friday. TTY/TDD users should call 1-800-325-0778; or
- Your State Medicaid Office.
Learn more about CMS Best Available Evidence (BAE) policy here.
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If you have any questions, please call Member Services at 1-866-571-0693, (TTY/TDD:
1-800-955-8771), Monday – Sunday, 8:00 AM to 8:00 PM.
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