Low Income Subsidy Premium Summary

Low Income Subsidy Premium Summary

Medicare provides “Extra Help” to pay prescription drug costs for people who have limited income and resources. Resources include your savings and stocks, but not your home or car. If you qualify, you get help paying for any Medicare drug plan's monthly premium, yearly deductible and prescription copayments. In addition, your premium will generally be lower when you receive help. This Extra Help also counts toward your out-of-pocket costs.

People with limited income and resources may qualify for Extra Help. Some people automatically qualify for Extra Help and don't need to apply. Medicare mails a letter to people who automatically qualify for Extra Help.

If you think you may qualify for Extra Help, call Social Security at 1-800-772-1213, TTY users can call 1-800-325-0778. You may also be able to apply at your State Medicaid Office, call 1-800-926-2588, TTY users can call 1-208-332-7205. After you apply, you will get a letter letting you know if you qualify for Extra Help and what you need to do next.

The premiums listed below are for medical services and prescirption drug benefits, but do not include any Part B premium you may have to pay.

True Blue Rx Option I HMO Low-Income Subsidy   True Blue Rx Option II HMO Low-Income Subsidy
2019 2020 2019 2020
$0 deductible $0 deductible $200 deductible $250 deductible
$0 deductible $0 deductible $85 deductible $89 deductible
$1.25 for generics and brands that are treated as generics $3.80 for brand name drugs $1.30 for generics and brands that are treated as generics $3.90 for brand name drugs $1.25 for generics and brands that are treated as generics $3.80 for brand name drugs  $1.30 for generics and brands that are treated as generics $3.90 for brand name drugs
$3.40 for generics and brands that are treated as generics $8.50 for brand name drugs $3.60 for generics and brands that are treated as generics $8.95 for brand name drugs $3.40 for generics and brands that are treated as generics $8.50 for brand name drugs $3.60 for generics and brands that are treated as generics $8.95 for brand name drugs
15% coinsurance for all drugs 15% coinsurance for all drugs 15% coinsurance for all drugs 15% coinsurance for all drugs
 
2020 Part D Premium True Blue Rx Option I HMO Service Area 1
  2020 Part D Premium True Blue Rx Option II HMO Service Area 1
Your level of extra help Monthly Premium for True Blue Plan 015-001 Your level of extra help Monthly Premium for True Blue Plan 016-001
100% $137.40 100% $92.70
75% $138.50 75% $93.30
50% $139.70 50% $93.80
25% $140.80 25% $94.40
 
2020 Part D Premium True Blue Rx Option I HMO Service Area 2
  2020 Part D Premium True Blue Rx Option II HMO Service Area 2
Your level of extra help Monthly Premium for True Blue Plan 015-002 Your level of extra help Monthly Premium for True Blue Plan 016-002
100% $119.20 100% $74.20
75% $128.40 75% $80.40
50% $137.60 50% $86.60
25% $146.80 25% $92.80

 

True Blue Rx HMO Low-Income Subsidy
2019 2020
$0 deductible $100 deductible
$0 deductible $89 deductible
$1.25 for generics and brands that are treated as generics $3.80 for brand name drugs  $1.30 for generics and brands that are treated as generics $3.90 for brand name drugs
$3.40 for generics and brands that are treated as generics $8.50 for brand name drugs  $3.60 for generics and brands that are treated as generics $8.95 for brand name drugs
15% coinsurance for all drugs  15% coinsurance for all drugs

 

2020 Part D Premium True Blue Rx HMO Service Area 1
  2020 Part D Premium True Blue Rx HMO Service Area 2
Your level of extra help Monthly Premium for True Blue Plan 019-001 Your level of extra help Monthly Premium for True Blue Plan 019-002
100% $55.00 100% $75.50
75% $55.00 75% $76.40
50% $55.00 50% $77.20
25% $55.00 25% $78.10

 

True Blue Rx Preferred HMO Low-Income Subsidy
  True Blue Rx Gem HMO Low-Income Subsidy
2019 2020 2019 2020
$100 deductible $150 deductible $125 deductible $150 deductible
$85 deductible $89 deductible $85 deductible $89 deductible
$1.25 for generics and brands that are treated as generics. $3.80 for brand name drugs $1.30 for generics and brands that are treated as generics. $3.90 for brand name drugs $1.25 for generics and brands that are treated as generics. $3.80 for brand name drugs $1.30 for generics and brands that are treated as generics. $3.90 for brand name drugs
$3.40 for generics and brands that are treated as generics. $8.50 for brand name drugs $3.60 for generics and brands that are treated as generics. $8.95 for brand name drugs $3.40 for generics and brands that are treated as generics. $8.50 for brand name drugs $3.60 for generics and brands that are treated as generics. $8.95 for brand name drugs
15% coinsurance for all drugs 15% coinsurance for all drugs 15% coinsurance for all drugs 15% coinsurance for all drugs

 

2020 Part D Premium True Blue Rx Preferred HMO
Your level of extra help Monthly Premium for True Blue Plan 021-000
100% $0.00
75% $0.00
50% $0.00
25% $0.00

 

2020 Part D Premium True Blue Rx Gem HMO Service Area 1
  2020 Part D Premium True Blue Rx Gem HMO Service Area 2
Your level of extra help Monthly Premium for True Blue Plan 022-001 Your level of extra help Monthly Premium for True Blue Plan 022-002
100% $15.00 100% $29.00
75% $15.00 75% $29.00
50% $15.00 50% $29.00
25% $15.00 25% $29.00

 

True Blue Rx St Luke's Health Partners (HMO) Low-Income-Subsidy
2019 2020
NA $175 deductible
NA $89 deductible
NA $1.30 for generics and brands that are treated as generics $3.90 for brand name drugs
NA $3.60 for generics and brands that are treated as generics $8.95 for brand name drugs
NA 15% coinsurance for all drugs

 

2020 Part D Premium True Blue Rx St Luke’s Health Partners (HMO) Service Area 1   2020 Part D Premium True Blue Rx St Luke’s Health Partners (HMO) Service Area 2
Your level of extra help Monthly Premium for True Blue Plan 023-001 Your level of extra help Monthly Premium for True Blue Plan 023-002
100% $0.00 100% $25.00
75% $0.00 75% $25.00
50% $0.00 50% $25.00
25% $0.00 25% $25.00
last update 10/1/2019

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