Help Paying for Prescriptions
If you have limited income and resources, you may qualify for Extra Help with the costs for your prescription drug coverage through the Medicare Part D Subsidy. If you qualify and enroll in a HAP Medicare Advantage plan with prescription drug coverage or Alliance Medicare Rx, both your copays and premiums may be less.
How does Extra Help from Medicare affect what I pay for prescription drugs?
If you qualify for Extra Help, your costs for prescription drugs will be one of the following, depending on the amount of Extra Help for which you qualify:
- $0 for generics and brands that are treated as generics; $0 for brand-name drugs
- $1.20 for generics and brands that are treated as generics; $3.70 for brand-name drugs
- $3.30 for generics and brands that are treated as generics; $8.25 for brand-name drugs
- 15% coinsurance or the Plan Option copay, whichever is less, for all drugs. At this level of Extra Help, if your plan includes an upfront prescription drug deductible, you must first pay the plan deductible. The maximum deductible you will pay in the year is $82.
Can I get Extra Help with premium costs?
If you qualify for Extra Help, Medicare may pay some or all of your Part D premium. The Extra Help is only for Part D prescription costs, not for medical benefits.
|Your level of
|HAP Senior Plus (HMO)||HAP Senior Plus (HMO-POS)|
|Option 0||Option 1||Option 2||Option 3|
|Your level of
|HAP Senior Plus Tiered Access (HMO)||HAP Senior Plus (PPO)|
|Option 2||Option 1||Option 2|
|LIS Category||LIS Drug Copay
|LIS Drug Copay
All Other Drugs
|4||$82.00 deductible and 15% or copay of the benefit, whichever is less.||$82.00 deductible and 15% or copay of the benefit, whichever is less.|
If you are already getting Extra Help, you may receive (or may have received) a letter from Medicare or the Social Security Administration (SSA) about your eligibility for Extra Help. Read this important information carefully.
If you don't know what level of Extra Help you qualify for, you can call (800) MEDICARE (800-633-4227) for this information. TTY/TDD users should call (877) 486-2048. Representatives are available 24 hours a day, seven days a week.
How does HAP know the level of Extra Help I am receiving for prescription drug costs?
We use the most current information available to us. This is known as the "Best Available Evidence." When our information or your level of Extra Help changes, appropriate adjustments will be made to your prescription drug expenses.
Find out more information about our use of the Best Available Evidence (You are leaving a Medicare-approved site)
How do I qualify for Extra Help?
To see if you qualify for getting Extra Help, call:
- (800) MEDICARE (800-633-4227), 24 hours a day, seven days a week.
TTY/TDD users should call (877) 486-2048
- The Social Security Administration at (800) 772-1213 between
7 a.m. and 7 p.m., Monday - Friday.
TTY/TDD users should call (800) 325-0778
- Your state Medicaid office
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