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Prospective Members, Enrolled Members

and Provider Inquiries: 800-405-9681 (TTY 711)

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.

PPHP accepts the following forms of evidence to establish the subsidy status of a beneficiary that is institutionalized and qualifies for zero cost-sharing:

  • Documentation from the facility showing Medicaid payments for a full calendar month
  • Documentation from the state that confirms Medicaid payment to the facility for a full calendar month
  • A screen print from State Medicaid showing the institutional status based on a full calendar month stay for Medicaid payment purposed

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

  • A copy of valid State Medicaid Card showing eligibility dates
  • Complete documentation of contact with State Medicaid verifying the Medicaid status (including date and time of contact, name, title, and phone number of the person contacted)
  • Documentation that confirms active Medicaid status
  • A printout from the State electronic enrollment file showing Medicaid status
  • A screen print from the State’s Medicaid systems showing Medicaid status
  • Other documentation provided by the State showing Medicaid status

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

PO BOX 26289 TAMPA, FL 33623

2021 Monthly Plan Premium 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 our Plan.

This table shows you what your Calendar Year 2021 monthly plan premium will be if you get extra help.

Your Level of Extra HelpMonthly Premium for Provider Partners Illinois Advantage Plan (HMO SNP) *
100%$0
75%$6.80
50%$13.70
25%$20.50
Your Level of Extra HelpMonthly Premium for Provider Partners Maryland Advantage Plan (HMO SNP) *
100%$0
75%$8.10
50%$16.10
25%$24.20
Your Level of Extra HelpMonthly Premium for Provider Partners Maryland Community Plan (HMO SNP) *
100%$0
75%$8.10
50%$16.10
25%$24.20
Your Level of Extra HelpMonthly Premium for Provider Partners Missouri Advantage Plan (HMO SNP) *
100%$0
75%$7.60
50%$15.20
25%$22.90
Your Level of Extra HelpMonthly Premium for Provider Partners Ohio Advantage Plan (HMO SNP) *
100%$0
75%$7.40
50%$14.90
25%$22.30
Your Level of Extra HelpMonthly Premium for Provider Partners Pennsylvania Advantage Plan (HMO SNP) *
100%$0
75%$9.40
50%$18.70
25%$28.10
Your Level of Extra HelpMonthly Premium for Provider Partners Pennsylvania Community Plan (HMO SNP) *
100%$0
75%$9.40
50%$18.70
25%$28.10

*This does not include any Medicare Part B premium you may have to pay. Provider Partners Health Plans premium includes coverage for both medical services and prescription drug coverage.

2021 Extra Help Premium Information

2021 Extra Help Table

To review the 2020 Extra Help Premium Information, click here.

Page Last Updated:  10/15/2020

Provider Partner Health Plans are HMO-SNPs with Medicare contracts. Enrollment in Provider Partner Health Plans depends on contract renewal. Y0135_PPHPWEB_2021