HealthChoice Medicare Supplement Plans With Part D
Extra Help Paying for Prescription Costs

Medicare Low Income Subsidy Information

There is a program available to help people who have limited income and resources as determined by Social Security. You may be able to get Extra Help paying your monthly premiums, pharmacy deductibles, and pharmacy copays. This Extra Help also counts toward your out-of-pocket maximum. If you think you may qualify or want more information, visit the Social Security website at www.socialsecurity.gov or call Social Security, Monday through Friday, 7:00 a.m. to 7:00 p.m., Central time, at:

• Toll-free 1-800-772-1213 or toll-free TTY/TDD 1-800-325-0778

You can also visit www.medicare.gov, or call Medicare, 24 hours a day, 7 days a week, at:

• Toll-free 1-800-MEDICARE (1-800-633-4227)
• Toll-free TTY/TDD 1-877-486-2048

Best Available Evidence Policy

In the absence of a letter from Social Security, HealthChoice will also accept other forms of verification to establish whether a member is qualified for Extra Help paying for prescription drug costs. To learn more about the Best Available Evidence Policy, click here.

If You Qualify for Extra Help

After you apply for Extra Help, you will get a letter letting you know whether or not you qualify and what you need to do next. You may receive full or partial help depending on your income, family size, and resources.

For the prescription drug portion of your coverage, you pay $0 or a reduced monthly premium if you qualify for Extra Help. It also helps you pay your prescription drug costs. If you qualify for Extra Help in 2012, the information below shows the assistance you will receive for the prescription drug portion of your coverage.

If you qualify for full help, the following benefits apply:

A premium reduction of $31.10
No pharmacy deductible
Continuous coverage (no Coverage Gap)
Maximum copays of $2.60 for generic/Preferred drugs and $6.50 for other drugs

If you qualify for partial help, the following benefits apply:

A premium reduction between $7.80 and $31.10
A pharmacy deductible of $65
Continuous coverage (no Coverage Gap)
Coinsurance of 15% (up to the out-of-pocket maximum)

If you qualify for Extra Help, Medicare notifies HealthChoice and then HealthChoice notifies you of the amount of Extra Help you will receive. If you qualify for Extra Help, HealthChoice will automatically move you to the Low Option Plan so you pay the lowest premium. If you want to elect the High Option Plan, please notify HealthChoice in writing at:

HealthChoice
3545 NW 58 Street, Suite 110
Oklahoma City, OK 73112

Your request can also be faxed to 1-405-747-8939.

If you qualify for Extra Help and believe you are paying an incorrect copay amount, HealthChoice will work with CMS to verify your copay level. If it is determined that your copay is incorrect, the Plan will update its system so that you pay the correct copay. If you paid a higher copay than you should have, HealthChoice will pay you back.

Note to members who live in a long-term care facility: If the pharmacy hasn’t collected copays from you and is carrying your copays as a debt you owe, HealthChoice can make payment directly to the pharmacy.