ODS Advantage PPORX Select (PPO) premium
The ODS Advantage PPORX Select monthly premium for 2012 is $128.30. You must continue to pay your Medicare Part B premium if not otherwise paid for under Medicaid or by another third party.
Payment options
Monthly payments may be made:
- Directly to ODS. Please make checks payable to ODS Health Plan, Inc.
- Through Electronic Funds Transfer (EFT) from your bank. Paying your premium through EFT ensures that your payment is always on time and frees you from the burden of mailing a monthly check.
- Deducted from your monthly Social Security or Railroad Board benefit check. If you choose to have the monthly premium automatically deducted from your Social Security or Railroad board benefit check, please be advised that it may take up to two or more months before deductions begin.
If it takes two months for deductions to begin, two monthly premiums will be withheld in a lump sum from your Social Security or Railroad board benefit check.
If it takes three months for deductions to begin, three monthly premiums will be withheld in a lump sum from your Social Security or Railroad board benefit check. You will never have a deduction that is more than three months worth of premiums.
If you would like more information on deducting your monthly premium from your Social Security or Railroad board benefit check, please contact member services.
ODS Advantage PPORX Select Monthly Plan Premium for People who get Extra Help from Medicare to Help Pay for their Prescription Drug Costs
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 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 wil be if you get extra help.
| Your level of extra help | Monthly premium for ODS Advantage PPORX Select* |
|---|---|
| 100 percent | $91.80* |
| 75 percent | $101.00* |
| 50 percent | $110.10* |
| 25 percent | $119.20* |
*This does not include any Medicare Part B premium you may have to pay.
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 2011 | You will pay this much in 2012 |
|---|---|
| $0 deductible | $0 deductible |
| $63 deductible | $65 deductible |
| $1.10 for generics and brands that are treated as generics | $1.10 for generics and brands that are treated as generics |
| $3.30 for brand-name drugs | $3.30 for brand-name drugs |
| $2.50 for generics and brands that are treated as generics | $2.60 for generics and brands that are treated as generics |
| $6.30 for brand-name drugs | $6.50 for brand-name drugs |
| 15 percent coinsurance for all drugs | 15 percent coinsurance for all drugs |
The ODS Advantage PPORX Select premium includes coverage for both medical services and prescription drug coverage.
You may receive a letter from Medicare or the Social Security Administration about your eligibility for extra help in 2012. Read this important information carefully. If you don't know what level of extra help you qualify for, you can call 800-MEDICARE (800-633-4227, TTY/TDD: 877-486-2048). Representatives are available 24 hours a day, seven days a week.
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., Seven days a week)
- Your state Medicaid office
- 800-MEDICARE (800-633-4227, TTY/TDD: 877-486-2048)
If you have any questions, please contact member services.
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 Social Security Income (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.
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