Low Income Subsidy Benefit Overview
If you have limited income and resources, Social Security may help you pay for your drug coverage.
Do You Need to Apply?
Some people will receive assistance automatically and do not need to apply. If you answer yes to any of the questions below, you automatically qualify for extra help and do not need to apply to Social Security:
- Do you have Medicare and full coverage from a state Medicaid program that currently pays for your prescriptions?
- Do you get Supplemental Security Income?
- Do you get help paying your Medicare premiums from your state Medicaid program (belong to a Medicare Savings Program)?
Should You Apply?
Find out if you should apply for extra help with your prescription drugs.
If you get extra help from Medicare to help pay for your Medicare prescription drug plan costs, your monthly plan premium will be lower. The amount of extra help you get will determine your total monthly plan premium as a member of our plan.
This table demonstrates what your monthly plan premium for 2010 will be if you get extra help.
| Your Extra Level of Help | Monthly Premium for Blue Rx Standard (PDP) Plan* | Monthly Premium for Blue Rx Enhanced (PDP) Plan* |
|---|---|---|
| 100% | $40.70 | $86.50 |
| 75% | $49.10 | $94.90 |
| 50% | $57.50 | $103.30 |
| 25% | $66.00 | $111.80 |
| No Extra Help | $74.40 | $120.20 |
*This does not include any Medicare Part B premium you may have to pay.
For more information on receiving Federal Extra Help, or to see if you qualify, call:
- 1-800-MEDICARE (1-800-633-4227). TTY/TDD users should call 1-877-486-2048, 24 hours a day/7 days a week.
- The Social Security Administration at 1-800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday. TTY/TDD users should call 1-800-325-0778. You can also visit the Social Security Web site.
- Your local State Medicaid Office.
State extra help programs
Maryland
Maryland has the Senior Prescription Drug Assistance Program (SPDAP):
- Provides two subsidies:
- Up to $25 per month for the Part D premium
- Up to $1200 a year for drug costs in the coverage gap
- Only open to eligible Maryland residents
- Call 1-800-551-5995 (8 a.m. - 5 p.m. EST, weekdays) TTY 1-800-877-5156 for more information about the Maryland SPDAP.
- Please note that Medi-CareFirst participates in the Premium and Coverage Gap Subsidy Programs offered by Maryland SPDAP.
| If the beneficiary has... | Eligible for MD SPDAP Premium Subsidy? | Eligible for MD SPDAP Coverage Gap Subsidy? |
|---|---|---|
| No Subsidy through Federal Extra Help but has Income at or below 300% of the Federal Poverty Level | Yes | Yes |
| Partial subsidy through Federal extra help | Yes | No |
| Full subsidy through Federal extra help | No | No |
Delaware
Delaware has two extra help programs for its residents:
- The Delaware Prescription Drug Assistance Program
- Provides assistance with premiums and other benefit related costs — up to $3000 in assistance provided per year.
- To be eligible, you must have an income up to 200% of the Federal Poverty Level and NOT be receiving full premium subsidy through the Federal Extra Help Program (FPL).
- Call 1-800-996-9969, and select option 2, then option 1.
- The Delaware Chronic Renal Disease Program
- Covers Part D deductibles, copays, and premiums.
- Call 1-800-996-9969, and select option 2, then option 1.
District of Columbia
The District of Columbia does not offer a State Prescription Drug Assistance Program.
Note: Please visit the CMS Web site for the most up-to-date changes on low-income subsidy rules. These are called "best available evidence" (BAE) policies, and can be found in the BAE section of the CMS Part D Web site.