Premium

The Capital Health Plan Advantage Plus (HMO) premium is $30.00 each month. You also must continue to pay your Medicare Part B premium.

Extra Help from Medicare

You may be able to get Extra Help to pay for your prescription drug premiums and costs.. The amount of extra help that you can get depends on your income and resources.

You can qualify if you are eligible for Medicaid as well as Medicare. You also may qualify if your yearly income is less than $16,245 (single with no dependents) or $21,855 (married and living with your spouse with no dependents), and your resources are less than $12,510 (single) or $25,010 (married and living with your spouse). Resources include your savings and stocks but not your home or car. (If you live in Alaska or Hawaii, or pay at least half of the living expenses of dependent family members, income limits are higher.) These figures are for 2010 and may change for 2011.

To see if you quality for Extra Help, call:

• 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048, 24 hours a day/7days 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; or
• Your State Medicaid Office

Review the LIS Premium Summary Chart to what your monthly premium will be if you qualify for Extra Help. The amounts on the chart do not include Medicare Part B premium you may have to pay.

Best Available Evidence

If you believe you have qualified for Extra Help and you believe that you are paying an incorrect cost-sharing amount when you get your prescription at a pharmacy, our plan has established a process that allows 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. For additional information, please contact Capital Health Plan Member Services at one of the numbers listed on this page or see the link below for "Best Available Evidence."

• Best Available Evidence

Medicare Part D Late Enrollment Penalty

If you did not join a Medicare prescription drug plan when you were first eligible, and you went without creditable prescription drug coverage (as good as Medicare's) for 63 continuous days or more, you may have to pay a late enrollment penalty when you join a plan. This penalty amount could change every year, and you will have to pay it as long as you have Medicare prescription drug coverage.

If you qualify for Extra Help, you may not have to pay a late enrollment penalty, or you may get help paying your late enrollment penalty.

If you must pay a late enrollment penalty, your penalty is calculated when you first join a Medicare drug plan. To estimate your penalty, count the number of full months that you delayed enrolling in a Medicare drug plan or the number of full months in which you did not have creditable prescription drug coverage if the break in coverage was 63 days or more.  The penalty is 1% for every month that you did not have creditable coverage.  For example, if you go 14 months without coverage, the penalty will be 14%.

Then Medicare determines the amount of the average monthly premium for Medicare drug plans.  For 2012, this average premium amount will be $31.08.

To estimate your monthly penalty, you multiply the penalty percentage and the average monthly premium and then round it to the nearest 10 cents.  In the example here it would be 14% times $31.08.  This equals $4.35 which rounds to $4.40. This penalty may increase every year.

If you disagree with your late enrollment penalty, you may be eligible to have it reconsidered (reviewed). Call Member Services at one of the telephone numbers on this page to find out more about the reconsideration process.

Note: If you change the way you pay your premium (from direct pay to premium withhold or premium withhold to direct pay) it could take up to three months for the change to take effect. You will be held responsible for all premiums.

Last updated: 10/01/2011