2013 Akamai Advantage Low Income Subsidy
What is the Low Income Subsidy?
For people with limited incomes and resources, extra financial help, called Low
Income Subsidy (LIS), may be available from the federal government. If you are having
trouble paying your plan premium, please contact HMSA Akamai Advantage
Customer Service to see if we can help. If you qualify for LIS assistance
for your Medicare prescription drug coverage costs, the amount of your premium and
cost at the pharmacy will be less.
How will the LIS change my premium and copayments?
| Subsidy |
Monthly Premium |
| Preferred |
Select Plus |
Select |
Secure |
| 1 (100%) |
$42.70 |
$14.50 |
$0.00 |
$0.00 |
| 2 (100%) |
$42.70 |
$14.50 |
$0.00 |
$0.00 |
| 3 (100%) |
$42.70 |
$14.50 |
$0.00 |
$0.00 |
| 4 (100%) |
$42.70 |
$14.50 |
$0.00 |
$0.00 |
| 4 (75%) |
$48.40 |
$19.40 |
$0.00 |
$0.00 |
| 4 (50%) |
$54.10 |
$24.20 |
$0.00 |
$0.00 |
| 4 (25%) |
$59.80 |
$29.10 |
$0.00 |
$0.00 |
| Subsidy |
Annual Deductible |
Copayment / Coinsurance* |
Catastrophic Copayment** |
| Preferred |
Select Plus |
Select |
Secure |
|
* Copayment amounts for generic and brand drugs, respectively. For
example, the first amount shown ($2.65) is the copayment for a generic
drug filled for a member who is in the LIS Category 1.
** After the True-Out-of-Pocket Limit is reached, the Catastrophic Copayment for
LIS Levels 1, 2, & 3 is $0.00 for both generic and brand drugs. The Catastrophic
Copayment amounts for LIS Level 4 are $2.65 for generic drugs and $6.60 for brand drugs.
NOTE: Beneficiaries receiving extra help are responsible for paying the monthly premium
amounts listed above. You must continue to pay your Medicare Part B premium.
|
| 1 (100%) |
$0.00 |
$0.00 |
$0.00 |
$0.00 |
$2.65 / $6.60 |
$0.00 / $0.00 |
| 2 (100%) |
$0.00 |
$0.00 |
$0.00 |
$0.00 |
$1.15 / $3.50 |
$0.00 / $0.00 |
| 3 (100%) |
$0.00 |
$0.00 |
$0.00 |
$0.00 |
$0.00 / $0.00 |
$0.00 / $0.00 |
| 4 (100%) |
$66.00 |
$0.00 |
$0.00 |
$0.00 |
15% |
$2.65 / $6.60 |
| 4 (75%) |
$66.00 |
$0.00 |
$0.00 |
$0.00 |
15% |
$2.65 / $6.60 |
| 4 (50%) |
$66.00 |
$0.00 |
$0.00 |
$0.00 |
15% |
$2.65 / $6.60 |
| 4 (25%) |
$66.00 |
$0.00 |
$0.00 |
$0.00 |
15% |
$2.65 / $6.60 |
How do I apply for the LIS?
Beneficiaries may apply for the LIS through Social Security or your state Medicaid agency.
For more information and an application for LIS, please call Social Security at
1 (800) 772-1213 or visit www.ssa.gov.
TTY users should call 1 (800) 325-0778, 7 a.m. to 7 p.m., Monday through Friday.
I already know that I qualify for the LIS. How do I get my premiums and copayments adjusted?
You must be a member of a Medicare Prescription Drug Plan (PDP) or a Medicare Advantage plan
with Prescription Drug (MAPD), such as Akamai Advantage, to receive this extra help. If you are
a member of an Akamai Advantage plan with prescription drug coverage and you qualify for
extra help, Medicare will notify HMSA that you qualify for extra help, and HMSA will
apply the extra help to your premium and copayments.
Akamai Advantage members with LIS can also notify HMSA directly about their LIS. We will
ask for documentation of your LIS award, such as a Medicaid card or an SSA award letter.
This documentation is called "Best Available Evidence" and it will help us to apply the
correct level of LIS as soon as possible.
You can find more information about presenting "Best Available Evidence" by visiting the CMS
website.
Akamai Advantage is a Health plan with a Medicare contract. The benefit information provided is a brief summary, not a complete description of benefits. For
more information contact the plan. Copayments and coinsurance may change on Jan. 1, 2014.
