Monthly plan premiums for people who get extra help from Medicare to help pay for their prescription drug costs
If you get extra help from Medicare to help pay for your Medicare prescription drug plan costs, your monthly plan premium will be lower than what it would be if you did not get extra help from Medicare. The amount of extra help you get will determine your total monthly plan premium as a member of one of our plans.
This table shows you what your monthly plan premium will be if you get extra help. View a PDF version of this chart.
| |
HMO plans |
PPO plan |
| Your level of extra help |
For Saver Basic Rx plan |
For Saver Enhanced Rx plan |
For Standard Basic Rx plan |
For Standard Enhanced Rx plan |
For Plus Basic Rx plan |
For Plus Enhanced Rx plan |
For Preferred Enhanced Rx plan |
| 100% |
$0 |
$19.00 |
$71.50 |
$90.60 |
$131.50 |
$150.50 |
$183.50 |
| 75% |
$7.00 |
$26.00 |
$78.60 |
$97.70 |
$138.60 |
$157.60 |
$190.60 |
| 50% |
$14.00 |
$33.00 |
$85.70 |
$104.80 |
$145.70 |
$164.70 |
$197.70 |
| 25% |
$21.00 |
$40.00 |
$92.90 |
$111.90 |
$152.90 |
$171.90 |
$204.90 |
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This does not include any Medicare Part B premium you may have to pay.
Fallon Senior Plan’s premium includes coverage for both medical services and prescription drug coverage.
If you aren’t getting extra help, you can see if you qualify by calling:
- 1-800-Medicare or TTY/TDD users
call
1-877-486-2048 (24 hours a day/7 days a week).
- Your State Medicaid Office, or
- The Social Security Administration at 1-800-772-1213. TTY/TDD users should call 1-800-325-0778 between 7 a.m. and 7 p.m., Monday through Friday.
For information about the Centers for Medicare & Medicaid Services (CMS) Best Available Evidence (BAE) policy, visit the CMS Web site.
To view the PDF file above, you may need to download a free copy of Adobe® Acrobat Reader software on your computer.
Call us toll-free at 1-888-340-5504 (TDD/TTY: 1-877-608-7677), 8 a.m. to 8 p.m., seven days a week.