How to Get Help with Drug Costs
Extra Help From Medicare
Many Medicare members are eligible to receive assistance with prescription drug costs and don’t even know it! If you meet qualifications, Medicare could pay up to 75% or more of your drug costs including monthly prescription drug premiums, annual deductibles, coinsurance and copayments. Qualified members will not have a coverage gap or late enrollment penalty.
Monthly Plan Premium Summary Chart
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**.
|Your Level of Extra Help||2022 CareSource Advantage (HMO)|
|100%||Region 2&3: $0|
Region 4: $11.50
|75%||Region 2: $6.20|
Region 3: $7.50
Region 4: $19.80
|50%||Region 2: $12.50|
Region 3: $15.00
Region 4: $28.20
|25%||Region 2: $18.70|
Region 3: $22.50
Region 4: $36.60
**This does not include any Medicare Part B premium you may have to pay. The premiums listed above include coverage for both medical services and prescription drug coverage.
Do You Qualify?
To see if you qualify, call one of the following:
- 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048, 24 hours a day/7 days a week;
- The Social Security office at 1-800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday. TTY users should call 1-800-325-0778 (applications); or
- Your state Medicaid office (applications)
Member Services is also available to answer questions at 1-844-607-2827 (TTY: 711). We are open 8 a.m. to 8 p.m. Monday through Friday, and from October 1 through March 31 we are open the same hours, seven days a week.
Best Available Evidence
If you believe you are qualified for Extra Help and you believe that you are paying an incorrect cost-sharing amount when you get your prescription at a pharmacy, CareSource has established a process that will allow you to either request assistance in obtaining evidence of your proper copayment level, or, if you already have the evidence, to provide this evidence to us. Please fax or mail your best available evidence documentation:
Fax to: 1-877-764-6310
Mail to: CareSource Medicare Advantage
P.O. Box 8738
Dayton, OH 45401-8738
When we receive the evidence showing your copayment level, we will update our system so that you can pay the correct copayment when you get your next prescription at the pharmacy. If you overpay your copayment, we will reimburse you. Either we will forward a check to you in the amount of your overpayment or we will offset future copayments. If the pharmacy hasn’t collected a copayment from you and is carrying your copayment as a debt owed by you, we may make the payment directly to the pharmacy. If the state paid on your behalf, we may make payment directly to the state. Please contact Member Services if you have questions.
For more information on providing best available evidence, please contact our Member Services department at 1-844-607-2827 (TTY: 711). We are open 8 a.m. to 8 p.m. Monday through Friday, and from October 1 through March 31 we are open the same hours, seven days a week.
Learn more about the best available evidence (BAE) policy on the CMS website.
Out-of-network/non-contracted providers are under no obligation to treat CareSource members, except in emergency situations. Please call our customer service number or see your Evidence of Coverage for more information, including the cost- sharing that applies to out-of-network services.