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Extra Help

Provider Directory Precertification Request Form

Formulary Shingles Vaccine Info. Rx Mail Order Form Out of Area Coverage Drug Management Programs Medication Therapy Management Programs Drug Exclusions Rx Determination Request Form Part D Coverage Determination Request Form Rx Prior Authorization

Complaints about Rx Coverage? How to File a Grievance How to File an Appeal Appoint a Representative Appeal & Grievance Form

Who Can Join? Summary of Benefits Evidence of Coverage Quality Program Ending Your Membership Disclaimers

Extra Help for Premiums

“Extra Help” from Medicare. This program is also called the “low-income subsidy” or LIS.

You may be able to get Extra Help to pay for your prescription drug premiums and costs. To see if you qualify for extra help, call:

1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048, 24 hours a day/7 days a week;
The Social Security Office at 1-800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday. TTY users should call, 1-800-325-0778; or
Your State Medicaid Office.

The links below include tables showing the monthly premiums for each
level of extra help, if you qualify.

Extra Help (2010 Plans)

Do you Qualify for Extra Help?

To see if you qualify for Extra Help with your prescription drug costs, click the link below to visit the Social Security Administration's (SSAs) website. SSA’s website includes general information about LIS and the application itself.

www.ssa.gov

Best Avaliable Evidence

For additional information and forms related to the usage of Best Avaliable Evidence (BAE) for Part D plans, click on the link below to visit the Centers for Medicare and Medicaid Services' (CMS) website.

www.cms.hhs.gov - BAE

Updated 7/2010

H3044_H1558_WHPWeb (10/2009)