Extra Help With Prescription Drug Costs

People with limited incomes may qualify for Extra Help to pay for their prescription drug costs. If eligible, Medicare could pay for seventy five (75) percent of 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 one of the numbers listed below.

If you qualify for extra help with your Medicare prescription drug plan costs, your premium and costs at the pharmacy may be lower. When you join an Health New England Medicare Advantage Plan with prescription drug coverage, Medicare will tell us how much extra help you are getting. Then, we will let you know the amount you will pay.

If you are not getting this extra help, you can see if you qualify by calling one of the numbers (or clicking on one of the links) listed below. To check directly on your extra help status or level, you also may contact one of the following numbers:

800-MEDICARE (800-633-4227), TTY/TDD users should call

877-486-2048, 24 hours a day/7 days a week.

Click on the link to access the www.medicare.gov site.

The Social Security Administration (SSA) at 800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday. TTY/TDD users should call, 800-325-0778 (Click here for a direct link to the SSA Web page - "Help With Medicare Prescription Drug Plan Costs.")

Your State Medicaid Office:

There are two programs that members needing assistance with Prescription Drug Costs can access. Our Health New England Medicare Advantage Plan works with both of these programs to make it as easy as possible for our members to receive assistance.

Low Income Subsidy (LIS) Program - A Federal program run through the Social Security department, also known as "Extra Help" (as explained above), to provide premium and co-payment assistance for those who meet certain income and asset guidelines. This document lists plan premiums for those receiving extra help through the LIS subsidy. If you qualify, your premium will generally be lower once you receive extra help.

2024 LIS Premium Subsidy Table for Massachusetts Plans

2023 LIS Premium Subsidy Table for Massachusetts Plans

If you believe that you qualify for extra help and you may be paying the wrong copayment amount for prescription drugs, please contact Member Services. We will work with you to update your LIS status based on the best available evidence. For example, you might provide us with evidence of Medicaid status, which may show that you qualify you for extra help. Once you provide us with acceptable evidence, we will update our system and notify CMS. When you go to the pharmacy, the copayment you pay will be based on the latest information we receive. For more information on acceptable forms of evidence, contact Member Services or click  here to access the CMS Best Available Evidence Policy.

Last updated: 10/1/23