PERS ODS Advantage PPORX premium
Your premium is collected by the PERS Health Insurance Program and forwarded to ODS. If you qualify for extra help from Medicare, called the low-income subsidy (LIS), you may not have to pay for part of your monthly premium.
If you have any questions about your plan premiums or the payment program, please call PERS Health Insurance Program Customer Service at 800-768-7377 (TTY 800-433-6313), Monday through Friday, from 7:30 a.m. to 5:30 p.m., Pacific Time.
Low-income subsidy
If you are receiving extra help from Medicare to pay for your prescription drugs and you will qualify for the same amount of help next year, the table below tells you how your prescription costs will change.
| If you paid this much in 2009 | You will pay this much in 2010 |
|---|---|
| $0 deductible | $0 deductible |
| $1.10 for generics and brands that are treated as generics | $1.10 for generics and brands that are treated as generics |
| $3.20 for brand-name drugs | $3.30 for brand-name drugs |
| $2.40 for generics and brands that are treated as generics | $2.50 for generics and brands that are treated as generics |
| $6 for brand-name drugs | $6.30 for brand-name drugs |
| 15 percent coinsurance for all drugs | 15 percent coinsurance for all drugs |
If you get extra help from Medicare to pay for your Medicare prescription drug plan costs, your monthly premium will be lower than it would be otherwise. The amount of help you get will determine your total monthly plan premium.
If you aren’t getting extra help, you can see if you qualify by calling:
- The Social Security Administration at 800-772-1213 (TTY/TDD: 800-325-0778 between 7 a.m. and 7 p.m., Monday through Friday)
- Your state Medicaid office
- 800-MEDICARE (800-633-4227, TTY/TDD: 877-486-2048)
If you have any questions, please contact member services.
If you qualify for the Medicare Part D premium subsidy and you choose the PERS ODS Advantage PPORX plan, you may have to pay the balance of the plan’s Part D premium.
Best available evidence (BAE)
Beneficiaries are “deemed” eligible for a low-income subsidy (LIS) if they are full-benefit Medicare/Medicaid-eligible, partial dual eligible, are receiving SSI or have applied and been awarded LIS by the Social Security Administration. There is a new process for assisting individuals who do not have the required pieces of evidence but claim to be eligible for LIS. If you do not have the required evidence called “best available evidence” (BAE) and believe you are LIS-eligible, please call member services.
For more information, visit the section of the Centers for Medicare and Medicaid Services website regarding BAE policy.
updated 10/2009
H3813-802
H3813_4006EGPPORX10A (11/2009)
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