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 may 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 Fallon Senior Plan HMO member.

The tables below show you what your monthly plan premium will be if you get Medicare's extra help.

Hampden county

View a PDF version of this chart (H9001_2012_670_109 CMSApproved 09222011, pdf)
Vea la versión PDF de esta tabla (H9001_2012_670_109SP CMSApproved 09222011, pdf)

Your level of extra help	Fallon Senior Plan Super Saver Rx HMO	Fallon Senior Plan Saver Rx HMO	Fallon Senior Plan Saver Enhanced Rx HMO	Fallon Senior Plan Standard Enhanced Rx HMO	Fallon Senior Plan Plus Enhanced Rx HMO
100%	$0	$2.60	$17	$57.50	$74.60
75%	$0	$3.40	$17	$60.40	$78.90
50%	$0	$4.30	$17	$63.20	$83.30
25%	$0	$5.10	$17	$66.10	$87.60

Worcester County and portions of Hampshire, Norfolk, Franklin and Middlesex Counties

View a PDF version of this chart (H9001_2012_670_109 CMSApproved 09222011, pdf)
Vea la versión PDF de esta tabla (H9001_2012_670_109SP CMSApproved 09222011, pdf)
 

Your level of extra help	Fallon Senior Plan Super Saver Rx HMO	Fallon Senior Plan Saver Rx HMO	Fallon Senior Plan Saver Enhanced Rx HMO	Fallon Senior Plan Standard Enhanced Rx HMO	Fallon Senior Plan Plus Enhanced Rx HMO
100%	$0	$44.90	$55.70	$121.70	$173.20
75%	$0	$47.20	$58.00	$125.80	$179.40
50%	$0	$49.40	$60.30	$129.80	$185.60
25%	$0	$51.70	$62.70	$133.90	$191.80

This does not include any Medicare Part B premium you may have to pay.

Fallon Senior Plan HMO's premiums for these plans include 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 (1-800-633-4227). TTY users call
  1-877-486-2048 (24 hours a day/seven days a week)
• Massachusetts Medicaid office:
  1-800-841-2900 (TTY: 1-800-497-4648)
• Social Security Administration: 1-800-772-1213
  (TTY: 1-800-325-0778), 7 a.m. to 7 p.m., Monday through Friday.

You can also call the numbers above to check your extra help status or level.

Massachusetts has a State Pharmaceutical Assistance Program called Prescription Advantage. This program may also provide assistance in helping you pay for your prescription drug costs. To find out if you qualify for Prescription Advantage, call 1-800-AGE-INFO (1-800-243-4636), TTY: 1-877-610-0241.

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.

H9001_2012_720_18 CMS Approved 10172011

The information on this page was last updated on 10/1/2011.