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New Options for Affordable Health Insurance

2012 Low Income Subsidy (LIS) Premium Information

Medicare provides “Extra Help” to pay prescription drug costs for people who have limited income and resources. Resources include your savings and stocks, but not your home or car. If you qualify, you get help paying for any Medicare drug plan’s monthly premium, yearly deductible and prescription copayments. In addition, your premium will generally be lower when you receive help. This Extra Help also counts toward your out-of-pocket costs.

People with limited income and resources may qualify for Extra Help. Some people automatically qualify for Extra Help and don’t need to apply. Medicare mails a letter to people who automatically qualify for Extra Help.

If you think you may qualify for Extra Help, call Social Security at 1-800-772-1213, TTY users can call 1-800-325-0778. You may also be able to apply at your State Medicaid Office, call 1-800-926-2588, TTY users can call 1-208-332-7205. After you apply, you will get a letter letting you know if you qualify for Extra Help and what you need to do next.

The premiums listed above are for medical services and prescirption drug benefits, but do not include any Part B premium you may have to pay. 
 

 True Blue HMO
Rx Option II
Low-Income Subsidy

True Blue HMO

Rx Option I
Low-Income Subsidy

True Blue Freedom HMO
Low-Income Subsidy

Secure Blue PPO
Low-Income Subsidy

2011

 2012

2011

2012

2012

2011

2012

 $260 deductible

$0 deductible

 $63 deductible

 $65 deductible

 $63 deductible

 $65 deductible

$65 deductible

 $63 deductible

 $65 deductible

 $1.10 for generics and brands that are treated as generics $3.30 for brand name drugs

$2.50 for generics and brands that are treated as generics $6.30 for brand name drugs

$2.60 for generics and brands that are treated as generics $6.50 for brand name drugs

$2.50 for generics and brands that are treated as generics $6.30 for brand name drugs

$2.60 for generics and brands that are treated as generics $6.50 for brand name drugs

$2.60 for generics and brands that are treated as generics $6.50 for brand name drugs

$2.50 for generics and brands that are treated as generics $6.30 for brand name drugs

$2.60 for generics and brands that are treated as generics $6.50 for brand name drugs

15% coinsurance for all drugs

True Blue HMO

Rx Option II

True Blue HMO

Rx Option I

True Blue Freedom HMO

Secure Blue PPO

Your level of extra help

Monthly Drug 
Premium
 

Your level of extra help

Monthly Drug 
Premium

Your level of extra help

Monthly Drug 
Premium

Your level of extra help

Monthly Drug 
Premium

100%

$3.10

100%

$2.20

100%

$0.00

100%

$0.00

75%

$13.40

75%

$12.50

75%

$0.00

75%

$7.80

50%

$23.60

50%

$22.70

50%

$0.00

50%

$15.60

25%

$33.80

25%

$32.90

25%

$0.00

25%

$23.40

 

Y0010_MK 12155 CMS Approval 11/9/2011