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HELP WITH PRESCRIPTION DRUG COSTS

The following information may be helpful for Medicare beneficiaries. This page provides an overview about Low Income Subsidy (LIS) qualifications & Best Available Evidence (BAE).

Help with Medicare Prescription Drug Costs (Low Income Subsidy)
If you have Medicare and have limited income and resources, you may qualify for extra help paying for your prescription drugs. If you qualify, you could pay between $1 to $6 for each drug. For more information,
visit the Medicare Web site (please note, by clicking on this link, you will leave the Senior Preferred website) or call Social Security at (800) 772-1213 or, for the hearing imparied, TTY/TDD (800) 325-0778.

If you are a Senior Preferred member that qualifies for Part D low income subsidy, please refer to the table below.

2017 Elite D

  • If your level of extra help is 100%, your premium is $0.
  • If your level of extra help is 75%, your premium is $5.60.
  • If your level of extra help is 50%, your premium is $11.20.
  • If your level of extra help is 25%, your premium is $16.90.

2017 Value D

  • If your level of extra help is 100%, your premium is $0.
  • If your level of extra help is 75%, your premium is $0.
  • If your level of extra help is 50%, your premium is $0.
  • If your level of extra help is 25%, your premium is $0.

Do you believe you have qualified for extra help and that you are paying an incorrect copayment amount?
If you believe you are paying an incorrect co-payment amount when you get your prescription at a pharmacy because you have qualified for extra help, Senior Preferred is here to help you confirm your eligibility. Senior Preferred follows 
Medicare’s Best Available Evidence Policy. Please note, by clicking on this link, you will leave the Senior Preferred website. If you have the necessary documentation (listed below), we can help resolve your eligibility issues. Call Customer Service at (800) 394-5566.

What is Best Available Evidence (BAE)?
BAE stands for Best Available Evidence and is used to determine the Medicaid eligibility status for members when it is not readily available in other applications. Medicare has outlined what is considered BAE and acceptable by Part D plan sponsors. Best available evidence policy is used when the low-income subsidy information in CMS's systems is not correct. Part D plan sponsors are required to accept any of the following forms of evidence to establish the subsidy status of a full benefit dual eligible beneficiary when provided by the beneficiary or the pharmacist, representative, family member or other individual acting on behalf of the beneficiary:


1.     A copy of the member’s Medicaid card which includes the member’s name and an eligibility date during the discrepant period OR

2.     A report of contact including the date a verification call was made to the State Medicaid Agency and the name, title and telephone number of the state staff person who verified the Medicaid status during the discrepant period OR

3.     A copy of a state document that confirms active Medicaid status during the discrepant period OR

4.     A print out from the State electronic enrollment file showing Medicaid status during the discrepant period OR

5.     A screen print from the State’s Medicaid systems showing Medicaid status during the discrepant period OR


6.     Other documentation provided by the State showing Medicaid status during the discrepant period


Institutionalized
To establish that the beneficiary is institutionalized and qualifies for a zero cost-sharing level, the plan sponsor must furnish one or more of the following forms of proof:

1. A remittance from the facility showing Medicaid payment for a full calendar month for that individual during the discrepant period

 OR

2. A copy of a state document that confirms Medicaid payment to the facility for a full calendar month on behalf of the individual OR

3. A screen print from the State’s Medicaid systems showing that individual’s institutional status based on at least a full calendar month stay for Medicaid payment purposes during the discrepant period

 
Beneficiaries determined eligible by SSA
Plan sponsors must accept a copy of the award letter from SSA presented by Medicare beneficiaries who applied and were found eligible for the Low Income Subsidy.

Where can I get more information about BAE?

You can visit the CMS Web site. Please note, by clicking on this link, you will leave the Senior Preferred website.

This web page was updated on September 27, 2016.