Lower Your Prescription Costs
Having trouble paying for your medications? If you meet certain income and resource limits, you may qualify for a program called Medicare Extra Help. This federal program helps pay the prescription costs, premiums, deductibles and coinsurance of Medicare prescription drug coverage.
In this program, also known as the Limited-Income Subsidy (LIS) program, the co-pays you pay for prescriptions is capped. The copay is reviewed and adjusted by Medicare each year. For example, in 2020, prescription costs are no more than $3.60 for each generic prescription, and no more than $8.95 for each brand-name covered drug for those enrolled in the program. In 2021 it is likely that the copay amounts will be different.
It is well worth finding out if you qualify the Extra Help program. The savings can be significant.
Contact Us to Help You Apply
Roman Brokers Insurance in Mesa, AZ represents a wide range of Medicare plans and options that will best suit your specific needs and wants. At no cost and no obligation to you, we can determine if you qualify and assist you to apply for the Medicare Extra Help Program, also the Medicare Savings Programs.
Roman Brokers Insurance compares companies and plans for the best possible combinations of costs, coverage and compatibility. Dan Roman, a licensed, insured, independent and experienced agent will walk you through the process and give a detailed explanation of the differences in each plan. Contact us today at 480-834-7447.
Some people pay only a portion of their Medicare drug plan premiums and deductibles based on their income level. In 2020, you may qualify if you have up to $19,140 in yearly income ($25,860 for a married couple) and up to $14,610 in resources ($29,160 for a married couple).
Countable resources include:
- Money in a checking or savings accounts
Resources NOT counted include:
- Your home
- One car
- Burial plot
- Up to $1,500 for burial expenses if you have put that money aside
- Other household and personal items
Some people qualify automatically for help with prescription out-of-pocket costs. You qualify automatically for lower prescription costs through Extra Help if you have Medicare and meet any of these conditions:
- You have full Medicaid coverage through the state of Arizona.
- You get help from Arizona’s Medicaid program paying your Part B premiums from a Medicare Savings Program.
- You get Supplemental Security Income (SSI) benefits.
Even if you automatically qualify this year, you may not qualify for Extra Help next year. Changes in your income or resources can impact whether or not you qualify for lower prescription drug costs through one of the programs listed above. You’ll get a notice in September if you no longer qualify. Even if you get this notice, you may still qualify for help with prescription costs, but you will need to apply to find out.
- If your co-payment amounts are going to change next year, you’ll get a notice (on orange paper) in the mail in early October with the new amounts.
- If you don’t get a notice from Medicare, you’ll keep the same level of Extra Help that you got for this year.
Other Ways to Lower Prescription Costs
- Contact Roman Brokers Insurance in Mesa, AZ at 480-834-7447 to compare Medicare prescription drug plans to find a plan with lower hospital, medical and prescription costs.
- Ask your doctor if there are generics that will work as well as your current brand-name drugs.
- Ask your doctor about less expensive brand-name drugs.
- Consider using mail-order pharmacies.
- Arizona may have programs that can help with prescription costs. For more information you can contact Arizona’s Medicaid office or the State Health Insurance Assistance Program (SHIP). Remember, you can reapply for Extra Help at any time if your income and resources change.
- Find out if the company that makes your drug offers help
Paying the Right Amount for Prescriptions
If you qualify for Extra Help but you are not sure if you are paying the right amount for your prescriptions, contact your drug plan. Your plan may ask you to give information to help them check the level of Extra Help you should get.
Examples of documents you should keep, and that you can send your plan if the amount you are paying is incorrect include:
- A purple “Deemed Status” notice from Medicare that says you qualify automatically for Extra Help. This notice means you qualify automatically for Extra Help because you have both Medicare and Medicaid, you are in a Medicare Savings Program, or you get Supplemental Security Income (SSI) benefits.
- A yellow or green automatic enrollment notice from Medicare. This notice means you qualify automatically for Extra Help because you qualify for Medicare and Medicaid and currently get Benefits through Original Medicare. You will be enrolled automatically in a Medicare Prescription Drug Plan unless you decline coverage or join a plan yourself.
- An Extra Help “Notice of Award” from Social Security. This notice tells you the level of Extra Help at which you qualify and includes the start date.
- An orange “Change in Extra Help Copayment” notice from Medicare that says your copayment amount will change next year. You’ll get this ORANGE notice if Social Security determines that you still automatically qualify for Extra Help, but will have different Copayment levels next year.
- If you have Supplemental Security Income (SSI), you can use your award letter from Social Security as confirmation that you have SSI.
As well, you can give your plan any of the documents listed below. Your plan must accept any of these documents as proof that you qualify for Extra Help. If you don’t have or cannot find any of these documents, ask your plan for help.
Proof you have Arizona Medicaid (AHCCCS) and live in an institution or get home- and community-based services
- A bill from an institution (like a nursing home).
- A copy of a state document showing Medicaid paid for your stay for at least a month.
- A print-out from your state’s Medicaid system showing you lived in the institution for at least a month.
- A document from your state that shows you have Medicaid and are getting home- and community-based services.
Other proof you have Arizona Medicaid (AHCCCS)
- A copy of your Medicaid AHCCCS card (if you have one).
- A copy of a state document that shows you have Medicaid.
- A print-out from a state electronic enrollment file that shows you have Medicaid.
- A screen print from your state’s Medicaid systems that shows you have Medicaid.
- Any other document from your state that shows you have Medicaid.
Once you give your plan this information, your plan must:
- Make sure you pay no more than the LIS drug coverage cost limit.
- Contact Medicare so we can get confirmation that you qualify, if it’s available. Your request can take anywhere from several days to up to 2 weeks to process, depending on the circumstances.
Be sure to tell your plan how many days of medication you have left. Your plan and Medicare will work to process your request before you run out of medication, if possible.
If you paid for prescriptions since you qualified for Extra Help and you aren’t enrolled in Medicare prescription drug coverage, you may be able to get some money back. Keep receipts with your prescription drug prices, and call your plan. Or, you can contact Medicare’s Limited Income Newly Eligible Transition (NET) Program at 1-800-783-1307 for more information (TTY: 711).
Contact Us to Help You at No Cost, No Obligation to You!
Roman Brokers Insurance in Mesa, AZ represents a wide range of Medicare plans and options that will best suit your specific needs and wants. We can help you apply for the Medicare Extra Help Program and the Medicare Savings Programs.
Roman Brokers Insurance compares companies and plans for the best possible fit to meet your needs and preferences. Dan Roman, a licensed, insured, independent and experienced agent will walk you through the process and give a detailed explanation of the differences in each plan. Contact Dan Roman today at 480-834-7447.