How to Get Help with Drug Costs
Low Income Subsidy (LIS) or “Extra Help” from CareSource Dual Advantage™ (HMO D-SNP)
You may be eligible to receive assistance with prescription drug costs. If you meet qualifications, Medicare pays a percentage of your drug costs, including monthly prescription drug premiums, annual deductibles, coinsurance and copayments.
Monthly Plan Premium Summary Chart
The amount of Extra Help you get will determine your total monthly plan premium. This table shows you what your monthly plan premium will be if you get Extra Help*.
2023
Your Level of Extra Help | 2023 CareSource Dual Advantage |
|---|---|
100% | $0 |
75% | OH: $8.70 | IN: $7.00 | GA: $9.30 |
50% | OH: $17.30 | IN: $14.00 | GA: $18.60 |
25% | 5% – OH: $26.00 | IN: $ 21.10 | GA: $28.00 |
*This excludes 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 1-833-230-2020 (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 called “Best Available Evidence (BAE).” You can request assistance for 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 BAE documentation:
Fax to: 1-844-417-6258
Mail to:
CareSource Dual Advantage Enrollment
P.O. Box 1294
Dayton, OH 45401-1294
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 on your copayment, we will reimburse you. We will either 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.
Have Questions?
For more information on providing best available evidence, please contact our Member Services team at 1-833-230-2020 (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.