Premium
Because you are eligible for Medicaid, you do not have to pay a monthly plan premium.
Deductible
The Part D Deductible is paid on your behalf and counts toward your out-of-pocket costs.
Cost Sharing (Co-Payment)
A co-payment is the fixed amount you pay each time you fill a prescription. Our plan has two tiers, and every drug is in one of the two tiers. Depending on your income level, your Medicare Part D co-payment will be either:
2012 Plan Year
– Tier 1 - $0 for generic drugs
– Tier 2 - $0 for brand name drugs
Our plan also includes drugs with a $0 co-payment. Please call customer service at 800-546-5677 for details about your coverage.
Low Income Subsidy (LIS)
Low income subsidy is a Medicare program to help people with limited income and resources pay Medicare prescription drug program costs, such as premiums, deductibles, and coinsurance. In Partnership, all members have Medicaid. This means all Partnership members with Medicare Part D receive Extra Help.
If you are a Medicare beneficiary and fill a prescription for a Medicare covered drug, you (or someone on your behalf) will pay part of the costs for your drug. This is called a co-payment. The co-payment for your drug depends on the tier of drug and your income level. The LIS Rider lists the drug co-payment amounts.
For information about Medicare Part D subsidies or your LIS status, you can call 1-800-MEDICARE (1-800-633-4227), 24 hours a day/7 days a week. TTY users should call 1-877-486-2048. You can contact the Social Security Administration at 1-800-772-1213, TTY 1-800-325-0778 or visit www.socialsecurity.gov. You may also contact the State Medicaid office at 1-800-362-3002, TTY 1-888-701-1251 or visit www.dhs.wisconsin.gov.
2012 Plan Year
LIS Rider - H5206_CHP_122_12 CMS Approved 12052011
LIS Premium Summary Table
Best Available Evidence (BAE)
Federal regulations specify the requirements of Part D sponsors in the administration of the low-income subsidy program - including the reduction of cost sharing for subsidy-eligible individuals. In certain cases, the Center for Medicare and Medicaid Services (CMS) has inaccurate information about a person's low-income subsidy status. This means that CHP may not have the correct information to determine a member's subsidy.
To address these situations, CMS created the Best Available Evidence (BAE) Policy. This policy requires CHP to establish the appropriate cost-sharing for low-income members when presented with evidence the member's information is not accurate. |
