LISSummary
MONTHLY PLAN PREMIUM FOR PEOPLE WHO GET EXTRA HELP FROM MEDICARE TO HELP PAY FOR THEIR PRESCRIPTION DRUG COSTS
If you get extra help from Medicare to help pay for your Medicare prescription drug plan costs, your monthly plan premium will be lower than what it would be if you did not get extra help from Medicare. The amount of extra help you get will determine your total monthly plan premium as a member of our Plan.
This table shows you what your monthly plan premium will be if you get extra help.
| Monthy Premiums: | |||||
|---|---|---|---|---|---|
|
YOUR LEVEL OF EXTRA HELP |
Super Plus (HMO C-SNP)* |
Super Complete (HMO C-SNP)* |
Dialysis Plus (HMO-POS C SNP)* |
Dialysis Complete (HMO-POS C SNP)* |
Honest Care (HMO)* |
|
100% |
$0 |
$0 |
$0 |
$0 |
$0 |
|
75% |
$0 |
$10.60 |
$0 |
$10.60 |
$0 |
|
50% |
$0 |
$21.30 |
$0 |
$21.30 |
$0 |
|
25% |
$0 |
$31.90 |
$0 |
$31.90 |
$0 |
*This does not include any Medicare Part B premium you may have to pay
Gold Kidney Health Plan’s premium includes coverage for both medical services and prescription drug coverage.
If you aren’t getting extra help, you can see if you qualify by calling:
- 1-800-Medicare or TTY users call 1-877-486-2048 (24 hours a day/7 days a week),
- Your State Medicaid Office, or
- The Social Security Administration at 1-800-772-1213, TTY users should call 1-800-325-0778 between 8 a.m. and 7 p.m., Monday through Friday.
If you have any questions, please call Member Services at 1-844-294-6535 (TTY users should call 711) from 8 a.m. to 8 p.m. local time, 7 days a week from October 1 through March 31, and 8 a.m. to 8 p.m. local time, Monday through Friday, from April 1 through September 30.
