Low income subsidy
If you qualify for extra help with your Medicare prescription drug plan costs, your premium and costs at the pharmacy will be lower. When you join one of our plans, Medicare will tell us how much extra help you are getting. Then we will let you know the amount you will pay.
How to inquire about Low Income Subsidy
If you are not getting this extra help, you can see if you qualify by calling Social Security at 1-800-772-1213 (TTY users should call 1-800-325-0778) or visit www.socialsecurity.gov on the Web.
The following chart outlines the premium amounts based on the various low income subsidy levels.
| 2012 Monthly Premiums |
Conventional Plan $67/month |
Premier Plan $99/month |
Premier Plan Plus $121/month |
| 25% Low Income Subsidy (LIS) |
N/A
|
You pay $93.30* |
You pay $112.80* |
| 50% Low Income Subsidy (LIS) |
N/A
|
You pay $87.70* |
You pay $104.50* |
| 75% Low Income Subsidy (LIS) |
N/A
|
You pay $82.00* |
You pay $96.30* |
| 100% Low Income Subsidy (LIS) |
N/A
|
You pay $76.40* |
You pay $88.10* |
* The premiums listed above include both medical service and prescription drug benefits. These premiums do not include any Medicare Part B premium you may have to pay.
See also Centers for Medicare and Medicaid Services (CMS) Best Available Evidence Policy at
CMS Best Available Evidence Policy.
In general, beneficiaries must use network pharmacies to access their prescription drug benefit, except in non-routine circumstances. Quantity limitations and restrictions may apply.
Last modified: October 1, 2011
H3811_MA4003_2012 CMS Approved 10/14/2011