When You Need Extra Help

Some people with limited resources and income also may be able to get “Extra Help” to pay for the costs of a Medicare prescription drug plan, including monthly premiums, annual deductibles and prescription co-payments.

You automatically qualify and do not need to apply for Extra Help if you have Medicare and meet one of the following conditions:

  • Have full Medicaid coverage
  • Have Supplemental Security Income (SSI) or
  • Participate in a state program that pays your Medicare premiums

If you have questions about “Extra Help,” call:

If you believe that your cost-sharing amount for any prescriptions is incorrect, PPHP can help you:

  • Request help to obtain evidence of your proper copay level, or
  • If you already have the evidence, to provide this evidence to us.

As a Part D plan sponsor, CMS regulations require us to have a process to help you determine if you are eligible for the Low Income Subsidy (LIS) when some of your documentation is missing or there is a conflict between the CMS system and your actual status.

Before you enroll, PPHP will tell you what your plan premium will be with a low-income subsidy.

2018 Maryland PPHP and Pennsylvania PPHP Extra Help Table

Your Level of Extra Help MONTHLY PREMIUM FOR PPHP
Provider Partners Maryland
Advantage Plan *
Provider Partners Pennsylvania
Advantage Plan *
100% $0 $0
75% $7.68 $9.15
50% $15.35 $18.30
25% $23.03 $27.45

 

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

2018 Extra Help Premium Information

2018 Maryland LIS Summary

2018 Pennsylvania LIS Summary

PPHP accepts the following forms of evidence to establish the subsidy status of a full benefit dual eligible individual:

  • Copy of valid State Medicaid card
  • Copy of valid document from State Medicaid confirming active status
  • Printed report from State Medicaid confirming active status
  • Screen print from State Medicaid confirming active status
  • Other material from State Medicaid confirming active status

These documents may be mailed to PPHP’s main office:

901 Elkridge Landing Road Suite #100, Linthicum Heights, MD 21090.

Provider Partners Health Plan of Illinois is a Health Plan with a Medicare Contract. Enrollment in Provider Partners of Illinois Health Plan depends on contract renewal.
H8067_002_PPHPWEB CMS Pending

Provider Partners Health Plan of Maryland is a Health Plan with a Medicare Contract. Enrollment in Provider Partners of Maryland Health Plan depends on contract renewal.
H8067_001_PPHPWEB CMS Pending

Provider Partners Health Plan of Ohio is a Health Plan with a Medicare Contract. Enrollment in Provider Partners of Ohio Health Plan depends on contract renewal.
H7119_001_PPHPWEB CMS Pending

Provider Partners Health Plan of Pennsylvania is a Health Plan with a Medicare Contract. Enrollment in Provider Partners of Pennsylvania Health Plan depends on contract renewal.
H4093_001_PPHPWEB CMS Pending

Last updated 11/01/2018

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