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Members and Providers Inquiries: 800-405-9681

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.

2020 PPHP Extra Help Table

Your Level of Extra Help BY State
Monthly Premium for Maryland Advantage Monthly Premium for Pennsylvania Advantage
100% $0 $0
75% $7.40 $8.90
50% $14.80 $17.80
25% $22.30 $26.70

 

Your Level of Extra Help BY State
Monthly Premium for Illinois Advantage Monthly Premium for Ohio Advantage
100% $o $0
75% $6.50 $7.10
50% $13.00 $14.20
25% $19.50 $21.40

 

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

2020 Extra Help Premium Information

2020 LIS Summary – All States

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:

785 Elkridge Landing Road Suite #300, Linthicum Heights, MD 21090.

Page Last Updated:  10/14/2019

Provider Partners Illinois Advantage is an HMO-SNP with a Medicare contract. Enrollment in Provider Partners Illinois Advantage depends on contract renewal. H3800_PPHPWEB_2020

Provider Partners Maryland Advantage is an HMO-SNP with a Medicare contract. Enrollment in Provider Partners Maryland Advantage depends on contract renewal. H8067_PPHPWEB_2020

Provider Partners Health Plans of Ohio is an HMO-SNP with a Medicare contract. Enrollment in Provider Partners Health Plans of Ohio depends on contract renewal. H7119_PPHPWEB_2020

Provider Partners Pennsylvania Advantage is an HMO-SNP with a Medicare contract. Enrollment in Provider Partners Pennsylvania Advantage depends on contract renewal. H4093_PPHPWEB_2020

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