Assistance for People with Low Incomes

The Medicare Prescription Drug, Improvement and Modernization Act created a prescription drug benefit through Medicare (called Medicare Prescription Drug Coverage or Part D). This law provides extra help with the cost of prescription drugs for those who qualify. This extra help is known as the Low Income Subsidy (LIS) Program. Please note, Mercy Care Advantage members members do NOT have a part D premium. Mercy Care Advantage is a $0 premium plan. MCA is available in Maricopa, Pima, and Santa Cruz counties.

• Low Income Subsidy (LIS) Rider – Benefit increase
• Low Income Subsidy (LIS) Rider – Benefit decrease

Do You Qualify for EXTRA HELP?

People with limited income and resources may qualify for extra help in one of two ways. The amount of extra help you get will depend on your income and resources.

• You automatically qualify for extra help and don't need to apply if you have full coverage from a state Medicaid Program like AHCCCS or get help from Medicaid paying your Medicare premiums or get supplemental security income benefits. You do not need to apply for the extra help as Medicare mails letters to those who automatically qualify.
• If you do not automatically qualify but have limited income and resources, you may file an application with the Social Security Administration at (800) 772-1213 or visit www.socialsecurity.gov. You may also apply at your State Medical Assistance (Medicaid) office at (602) 417-4000 or 1-800-654-8713 or visit www.healthearizona.org. They will determine if you meet the eligibility criteria.

Remember: Mercy Care Advantage members automatically qualify for this low-income subsidy because you have Medicaid (AHCCCS/ALTCS)!

How Much Do You Pay for Drugs Covered by This Plan?

If you qualify for extra help with your drug costs, the cost for your drugs would normally depend on your income and coverage levels, the type of drug it is and whether you are filling your prescription at an in-network or out-of-network pharmacy. To review the Eligibility and Benefits Table see below.

Table 1. Eligibility and Benefits, Part D Low-Income Prescription Drug Subsidies

Your monthly plan premium is	Your yearly deductible is	Your co-payment amount for generic/preferred multi-source drugs is no more than	Your co-payment amount for all other drugs is no more than
$0	$0	$0/$1.10/$2.60 (each prescription)	$0/$3.30/$6.50 (each prescription)

* There is a $0 copay for those who have met institutionalized status in the current year or who have reached maximum out-of-pocket coverage.

* The monthly plan premium does not include any Medicare Part B premium that you may still need to pay. The plan premium you pay has been calculated based on the Plan’s premium and the amount of extra help you get. The premiums listed are for your prescription drugs, as well as your prescription drug benefits.