LIS Premium Summary Chart
Capital Health Plan Advantage Plus (HMO) and Capital Health Plan Preferred Advantage (HMO)
Monthly Plan Premium for People who get Extra Help from Medicare to Help Pay for their Prescription Drug Costs
Last updated: 10/01/2011
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 | Monthly Premium for Capital Health Plan Advantage Plus* | Monthly Premium Capital Health Plan Preferred Advantage* |
| 100% | $10.40 | $72.20 |
| 75% | $15.30 | $78.10 |
| 50% | $20.20 | $84.10 |
| 25% | $25.10 | $90.00 |
*This does not include any Medicare Part B premium you may have to pay.
Capital Health Plan Advantage Plus and Capital Health Plan Preferred Advantage's premium includes coverage for both medical 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 7 a.m. and 7 p.m., Monday through Friday.
If you have questions, please call Member Services at 850-523-7441 or 1-877-247-6512, (TTY: 850-383-3534 or 1-877-870-8943), 8 a.m. to 8 p.m. Eastern and Central, seven days a week.
Last updated: 10/01/2011
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