Extra Help Express Scripts

To have Medicare prescription drug coverage, you must belong to a Medicare-approved prescription drug plan like Express Scripts Medicare. CMS has automatically enrolled or reassigned you to Express Scripts Medicare because:

·         You are a full benefit, dual-eligible beneficiary (which means you have both Medicare and Medicaid); you take part in a Medicare Savings Program; or you get Supplemental Security Income (SSI).
OR

·         You applied and were approved for Extra Help, also called the low-income subsidy (LIS).

·         You have been automatically enrolled into a Medicare prescription drug plan in the past, and you continue to receive Extra Help in 2019.

·         You or your authorized representative did not voluntarily choose to enroll in another Medicare prescription drug plan.

·         Your current prescription drug plan has a premium in 2020 that is higher than the minimum amount required by CMS, or your Medicare prescription drug plan is terminating at the end of 2019.

Medicare will help pay for some or all of your prescription drug costs.

The amount of help you receive depends on your income and resources. The tables below show how much you will pay for your monthly premium, yearly deductible and prescription drug copayments, based on which situation applies to you. You can also use the amounts shown in the letter you received from CMS to determine your costs.

A.       If you have Medicare and full Medicaid coverage, and are receiving in-patient care in a medical institution or skilled nursing facility:

Your monthly premium is:	Varies by Region † View state level premiums now
Your yearly deductible is:	$0.00
Your copayment for generic drugs (including brand drugs treated as generics) is no more than:	$0.00
Your copayment for all other drugs is no more than:	$0.00

B.       If you have Medicare and full Medicaid coverage, income at or below 100% of the federal poverty level, and are living at home or outside a medical institution or skilled nursing facility:

Your monthly premium is:	Varies by Region † View state level premiums now
Your yearly deductible is:	$0.00
Your copayment for generic drugs (including brand drugs treated as generics) is no more than:	$1.30
Your copayment for all other drugs is no more than:	$3.90

C.       If you have Medicare and full Medicaid coverage, income above 100% of the federal poverty level, and are living at home or outside a medical institution or skilled nursing facility:

Your monthly premium is:	Varies by Region † View state level premiums now
Your yearly deductible is:	$0.00
Your copayment for generic drugs (including brand drugs treated as generics) is no more than:	$3.60
Your copayment for all other drugs is no more than:	$8.95

Please note: You will pay the same copayment as set by Medicare at any network pharmacy. Pricing and references to retail pharmacies with preferred cost-sharing that appear elsewhere on this website do not apply to you.

https://www.express-scriptsmedicare.com/medicare-part-d-automatic-enrollment.shtml