UPDATED Jan. 31, 2019. 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.
For people with income less than 135% of the Federal Poverty Level (FPL), the benefits include:
- No monthly premium
- No annual deductible
- Composed of $1.25 for generic and $3.80 for brand name (for income less than 100% of the FPL)
- Composed of $3.40 for generic and $8.50 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
- $85 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 special consideration.
Medicare Extra Help for Medicare Advantage Plans (MAPD)
The total premium for any Medicare Advantage plan that includes a Prescription Drugs Plan (MAPD) actually consists of two parts:
- Health (Medical) Portion of Premium
- Prescription Drugs (Rx) Portion of 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, a MAPD plan with total premium $69/month having Health premium $33/month and Drug 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:
- There is no charge for Drug portion of Premium. Therefore, the Total monthly premium is $33.
- No annual deductible for the prescription drugs
- Composed of $1.25 ($3.40) for generic and $3.80 ($8.50) for brand name
US Government Sources
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