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?
People with limited incomes may qualify for extra help to pay for their prescription drug costs. If eligible, Medicare could pay for up 75 percent or more 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 your local Social Security office or call Social Security at 1-800-772-1213. TTY users should call 1-800-325-0778. You can also apply for extra help online at www.socialsecurity.gov/prescriptionhelp.
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 2012 will be if you get extra help.
| Your Extra Level of Help | Monthly Premium for BlueRx Standard (PDP) Plan* | Monthly Premium for BlueRx Enhanced (PDP) Plan* |
|---|---|---|
| 100% | $52.50 | $97.20 |
| 75% | $61.20 | $105.90 |
| 50% | $69.80 | $114.50 |
| 25% | $78.50 | $123.20 |
| No Extra Help | $87.10 | $131.80 |
*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.
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.
State extra help programs
Maryland
Maryland has the Senior Prescription Drug Assistance Program (SPDAP):
- Provides subsidies for premiums and member copays/coinsurance 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
If you live in Delaware and think you might be eligible for extra help, please call the Delaware Prescription Drug Assistance or Delaware Chronic Renal Disease programs at 1-800-996-9969 (TTY: 800-232-5460). Select option 2, then option 1.
District of Columbia
The District of Columbia does not offer a State Prescription Drug Assistance Program.