Medicare Extra Help for Medicare Advantage Plans (MAPD)

There is plenty of information on how Medicare Extra Help will help people to reduce their Prescription Drug Costs. It primarily describes who is eligible for those programs and what benefits they provide as far as a stand alone Prescription Drug Plan (Part D). Much less information is available on the role of the Medicare Extra Help for Medicare Advantage Plans with Prescription Drugs (MAPD). This post will fill this void.

Medicare Extra Help

The Federal Medicare Extra Help program, also referred as the Low Income Subsidy (LIS) program, is for people with full Medicaid coverage as well as for people who are not on Medicaid but who have limited income. (See Medicare Extra Help / Low Income Subsidy (LIS)).

For people with income less than 135% of the Federal Poverty Level (FPL), the benefits include:

  • No monthly premium
  • No annual deductible
  • Composed of $1.15 for generic and $3.50 for brand name (for income less than 100% of the FPL)
  • Composed of $2.65 for generic and $6.60 for brand name (for income less than 135% of the FPL)

For people with income more than 135% of the Federal Poverty Level (FPL) but less than 150%, the benefits include:

  • Sliding scale monthly premium
  • $66 annual deductible
  • 15% coinsurance or the plan associated copay, whichever is less

Similar Pharmacy Assistance programs exist at the State level (such as PACE and PACENET in Pennsylvania, and PAAD in New Jersey). They normally allow participation for people having higher income who will not be eligible for Federal LIS programs.

The above information is relevant for the stand alone Prescription Drug Plan. Medicare Extra Help for Medicare Advantage Plans with Prescription Drugs (MAPD) deserves a special consideration.

Medicare Extra Help for Medicare Advantage Plans with Prescription Drugs (MAPD)

The total premium for any Medicare Advantage plan that includes a Prescription Drugs Plan (MAPD) actually consists of two parts:

  • Medical Premium
  • Prescription Drugs (Rx) Premium

Medicare Extra Help programs, either on a Federal or on State levels, will have an impact on the Prescription Drug portion of the MAPD plan, but not on its Medical portion. All considerations above for the stand alone PDP plan will be applicable to the MAPD plan.

Consider, for example, an MAPD plan with total premium $69/month having Medical premium $33/month and Rx Premium $36/month. Anybody entitled for the zero monthly premium for the stand alone Part D under Federal or State programs, may expect the following benefits will apply to this MAPD plan:

  • $33 monthly premium
  • No annual deductible for the prescription drugs
  • Composed of $1.15 ($2.65) for generic and $3.50 ($6.60) for brand name 

 

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