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McLaren Medicare
Extra Help Paying for Prescriptions

Extra Help Paying for Prescriptions with Medicare

McLaren Medicare Prescription Assistance

If you need help paying for prescriptions, you may qualify for a medication assistance program. These programs will lower your medication costs when you’re enrolled in a Medicare Part D plan or a Medicare Advantage plan.

Are Medication Assistance Programs Available Through Medicare?

Several medication assistance programs can help lower your medication costs. These programs help you get the medication you need at an affordable price. With medication assistance, you can take your medications as directed, without stressing about the cost.

If you’re a Medicare beneficiary with limited income and resources, you may qualify for “Extra Help” to cover your Medicare Part D prescription drug costs. You can get help paying for monthly premiums, yearly deductibles, co-payments and coinsurance. In addition, people who qualify for Extra Help won’t have a coverage gap and will not pay a late enrollment penalty.

How Do I Qualify for Extra Help with Medication Costs?

You can qualify for prescription assistance programs through Medicare if you’re enrolled in Original Medicare Part A and Part B and you have a low income.

To find out if you qualify for Extra Help you can:

  • Visit the Social Security Administration website and click on the Find Out if You Qualify button.
  • Call Social Security at 800-772-1213 (TTY: 800-325-0778) to ask questions about Extra Help.
  • Call Medicare at 800-633-4227 (TTY: 1-877-486-2048).
  • Call Michigan Medicaid at 517-241-3740 (TTY: 711).

Getting Help Paying for Medicare Prescription Drugs

Some Medicare beneficiaries with limited income and resources can qualify for “Extra Help” to pay for their Medicare Part D (prescription drug) monthly premiums, annual deductibles, and co-payments.  In addition, people who qualify for Extra Help will have no coverage gap and will not pay a late enrollment penalty.

To find our if you qualify you can:

  • Visit Social Security Administration and click on the “Find Out if You Qualify” button,
  • Call Social Security at 800-772-1213 (TTY: 800-325-0778) to apply over the phone,
  • Call Medicare at 800-633-4227, 24 hours a day, seven days a week,
  • Call your Michigan Medicaid Office

You’ll need to provide information about your income and your resources, including your savings, investments, IRAs and any real estate other than your home. If you’re married, you’ll also need to provide information for both you and your spouse. To qualify for Extra Help, your yearly income must be below $20,385 for an individual or $27,465 for a couple. Your resources need to be below $15,510 for an individual or $30,950 for a couple.

How to Apply for Prescription Cost Assistance Online

  • Fill out an online application form with the Social Security Administration. This is the easiest and fastest way to apply for Extra Help.
  • Call Social Security 1-800-772-1213 (TTY 1-800-325-0778). You can fill out the application on the phone, or ask for help filling out the online application.
  • Apply in person at your local Social Security Administration office. You can find your nearest office using the Social Security Office Locator.

After you apply for Extra Help, your application is reviewed by the Social Security Administration. You’ll get a letter in the mail if you qualify for Extra Help. Your benefits start as soon as you join a Medicare Part D prescription drug plan or a Medicare Advantage plan.

What do I pay if I qualify for Extra Help?

What you pay for your McLaren Medicare monthly plan premium depends on the level of Extra Help you receive from Medicare. The table below shows what your total monthly plan premium* will be if you get Extra Help:

Your Level of Extra Help

McLaren Medicare Inspire

McLaren Medicare Inspire Plus

McLaren Medicare Inspire Flex

100%

$0

$0

$17.50

75%

$0

$6.20

$25.40

50%

$0

$12.50

$33.30

25%

$0

$18.70

$41.10

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

Best Available Evidence

If you qualify for Extra Help, but believe that you are paying the wrong copay amounts at your pharmacy, McLaren Medicare can assist you with getting the evidence of your correct copay amounts.  If you already have the evidence, you can provide that to us.  Call Member Services at 833-358-2404 (TTY: 711) if you have questions or for more information on how to send us your evidence.  

You can visit the CMS website to learn more about the Best Available Evidence (BAE) policy.

Other Ways to Apply for RX Cost Assistance

Extra Help isn’t the only assistance program that helps pay medication costs. You can also apply for Medicaid in Michigan to help cover your health care costs. Coverage can include outpatient prescription drugs and pharmacy coverage options.

The Michigan Drug Assistance Program may also lower your medication costs. This state-run program covers medication copayments and coinsurance.

Finally, you can find out if the pharmaceutical company that makes your medications will help pay for the medication. Use the Pharmaceutical Assistance Program tool on the Medicare website to explore assistance programs from manufacturers. Start by entering the name of your drug, then hit the Find Programs button. You’ll see a list of any drug savings programs that may help cover the cost of your prescription medications.