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I am qualified for Medicaid and receive full Medicare Part D Extra Help, so why is my 2016 Medicare drug plan charging me a $3.80 premium in 2017?

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I am qualified for Medicaid and receive full Medicare Part D Extra Help, so why is my 2016 Medicare drug plan charging me a $3.80 premium in 2017?

Published on 2017-01-02 15:30:54Category: Medicaid, LIS, & Extra Help

Your chosen 2016 Medicare Part D plan no longer qualifies for your state's full-benefit LIS $0 monthly premium in 2017.

For example, the 2016 Florida AARP MedicareRx Saver Plus (PDP) plan qualified for the full-LIS $0 monthly premium. However, the same AARP Part D plan no longer qualifies for the $0 premium in 2017. Rather, the monthly premium for people with a 100% LIS benefit is $3.80.

And for more details: You can click here to read more about how to view the full (100% LIS) or partial LIS premiums for any Medicare Part D plan.

See the chart below for more 2017 prescription plans that no longer qualify for the $0 monthly premium in 2017, but did qualify in 2016.

As background:  If you are qualified to receive Medicaid, then you automatically qualify for the Medicare Part D Extra Help program and the cost of your Medicare Part D premium will be covered up to a certain level – called your state’s Low-Income Subsidy (LIS) Benchmark Premium.

For example, if you live in a state with a benchmark premium of $25, the Medicare Part D Extra Help program will pay for the premium up to this level (or slightly above) and you will have a $0 premium.

But if you monthly premium is over this $25 amount, you will be charged the additional cost over this benchmark. So, in our example, if you Medicare plan has a $30 monthly premium, you may be charged the $5 additional cost over your state's benchmark premium.

2017 LIS Benchmark Premiums: You can see a list of the 2017 Medicare Part D benchmark premiums for each state in our Blog: “2017 Low-Income Subsidy Benchmark Premium Amounts (includes 2017 - 2006 for comparison)”: https://q1medicare.com/q1group/MedicareAdvantagePartD/Blog.php?blog_id=580

The good news is that, if you qualify for the full Medicare Part D Low-Income Subsidy (LIS or Extra Help), each year Medicare will automatically enroll you in a Medicare Part D plan that qualifies for your state’s $0 monthly premium. 

However, you have the right to select your own Medicare Part D plan at any time during the plan year.

Important:  If you select your own plan, Medicare considers you a "Chooser"  and does not automatically change your enrollment for the next plan year -- even if your selected Medicare Part D plan no longer qualifies for the state’s full-LIS $0 monthly premium.

The good news is that since you do receive "Extra Help" you can change your Medicare Part D plan at any time throughout the year to a drug plan that does qualify for the $0 monthly premium (and covers all of your medication needs) and your new coverage will take effect on the first day of the month after your enrollment.

Stand-alone Medicare Part D Prescription Drug Plans (PDP)
No Longer Qualifying for the full-LIS (Extra Help)
$0 Monthly Premium in 2017
2017 Plan Name Full Premium 100% Subsidy 75% Subsidy 50% Subsidy 25% Subsidy
FL AARP MedicareRx Saver Plus (PDP) $32.90 $3.80 $11.10 $18.30 $25.60
MI AARP MedicareRx Saver Plus (PDP) $40.20 $6.00 $14.60 $23.10 $31.70
NV AARP MedicareRx Saver Plus (PDP) $29.90 $2.80 $9.60 $16.40 $23.10
AK Aetna Medicare Rx Saver (PDP) $38.40 $4.30 $12.90 $21.40 $29.90
TX Symphonix Value Rx (PDP) $43.00 $15.70 $22.50 $29.30 $36.20
GA Symphonix Value Rx (PDP) $33.90 $7.50 $14.10 $20.70 $27.30
CO Symphonix Value Rx (PDP) $34.40 $2.40 $10.40 $18.40 $26.40
MO Symphonix Value Rx (PDP) $41.10 $11.00 $18.50 $26.10 $33.60
AK Symphonix Value Rx (PDP) $39.20 $5.10 $13.70 $22.20 $30.70
CA EnvisionRxPlus (PDP) $53.90 $17.60 $26.70 $35.80 $44.80
NJ EnvisionRxPlus (PDP) $47.30 $6.50 $16.70 $26.90 $37.10
VA EnvisionRxPlus (PDP) $37.40 $4.90 $13.00 $21.10 $29.30
ME NH Magellan Rx Medicare Basic (PDP) $38.30 $5.30 $13.60 $21.80 $30.10

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