Low income subsidy premium summary table
This table shows you what your monthly plan premium will be since you get extra help from Medicare to help pay for your Medicare prescription drug plan costs.
| Your level of extra help | Monthly premium you'll pay |
|---|
| 100% |
$0 |
| 75% |
$0 |
| 50% |
$0 |
| 25% |
$0 |
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 MassHealth office: 1-800-841-2900 (TTY: 1-800-497-4648)
- Social Security Administration: 1-800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday. TTY users call 1-800-325-0778.
- Prescription Advantage: 1-800-AGE-INFO (1-800-243-4636), TTY: 1-877-610-0241
You can also call the numbers above to check your extra help status or level.
For information about the Centers for Medicare & Medicaid Services (CMS) Best Available Evidence (BAE) policy, visit the CMS Web site.
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 it would be if you did not get any extra help from Medicare.
You must continue to pay your Medicare Part B premium (unless your Part B premium is paid for you by MassHealth (Medicaid) or another third party).
The NaviCare HMO SNP premium includes coverage for both medical services and prescription drug coverage.
H9001_N_2012_15_r3 Pending CMS Approval
The information on this page was last updated on 1/20/2012.