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I am qualified for Medicaid and receive full Medicare Part D Extra Help, so why is my drug plan charging me an $11 monthly premium?

Category: Medicaid, LIS, & Extra Help
Published: Jan, 06 2016 02:01:57
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Your chosen Medicare Part D prescription drug plan exceeds your state's Medicare Part D $0 benchmark premium.

If you are qualified for full Extra Help or the Medicare Part D Low-Income Subsidy (LIS), then you will pay a $0 premium when enrolled in a stand-alone Medicare Part D plan that meets your state’s LIS benchmark premium.

However, if your chosen Medicare Part D plan has a premium that exceeds the state's benchmark premium, you will pay a portion of the plan's monthly premium. 

Please note (as explained in more detail below):  If you qualify for the full Medicare Part D Low-Income Subsidy (LIS or Extra Help), Medicare will auto-enroll you into a Medicare Part D plan that qualifies for your state’s $0 monthly premium.  However, you have the right to select your own Medicare Part D plan at any time during the plan year.  If you select your own Medicare plan, Medicare does not automatically change your enrollment for the next plan year -- even if your selected Medicare Part D plan no longer qualifies for the state’s full-LIS $0 monthly premium.

So, in your case, it is possible that your chosen 2015 Medicare Part D plan qualified for the full LIS $0 premium, however your Medicare Part D plan no longer qualifies for the $0 premium in 2016.

For example, the Florida Aetna Medicare Rx Saver (PDP) plan qualified for the $0 premium in 2015, but it no longer qualifies for the $0 premium in 2016.

This means that, even if you qualify for 100% LIS, the monthly Medicare Part D premium is $11.00 - and not $0.

A chart of the monthly premium at 25%, 50%, 75%, and 100% is shown on our 2016 Aetna Medicare Rx Saver (PDP) Plan Benefits & Contact page and looks like this:

2016 Florida Aetna Medicare Rx Saver (PDP)
Full
Premium		 25%
Subsidy		 50%
Subsidy		 75%
Subsidy		 100%
Subsidy
$39.10 $32.10 $25.10 $18.00 $11.00

 

All of our Medicare plan finder (PDP-Finder.com or MA-Finder.com) and comparison tools show if a plan qualifies for the full LIS $0 monthly premium. As shown in the results of our PDP-Compare.com for 2016 Florida Aetna plans, you can see (circled in red below) that the Aetna Medicare Rx Saver plan no longer qualifies for the $0 premium.

Florida Aetna Medicare Part D plan changes 2015 to 2016

 

"Choosers" vs. Auto-Enrollees:
If you select your own Medicare Part D plan rather than having Medicare auto-enroll you in a Medicare Part D plan, Medicare considers you a "Chooser".  If you are a "Chooser" Medicare does not change your selected Medicare Part D plan for the next plan year -- even if your chosen plan no longer qualifies for the full LIS $0 monthly premium.

Keep in mind that beneficiaries receiving Extra Help have a continuous Special Enrollment Period (SEP). At any time through out the plan year, you can use this SEP to enroll in a new Medicare Prescription Drug plan and your new plan will take effect on the first day of the following month. You can determine your premium (based on your LIS Subsidy) for all Medicare Part D plans through our PDP-Finder.

All Medicare Part D plans, even Part D plans that do not qualify for the full LIS $0 premium, can offer their plans at a reduced premium for people receiving full or partial Extra Help. Our PDP-Finder.com Florida Medicare Part D plans - 100% LIS premium search shows there are 22 plans available in Florida ranging in premium from $0 to $146.60. To see premiums for the various full and partial LIS subsidies, you would select the appropriate subsidy level in the criteria box. See the red box in the image below:

PDP-Finder LIS Subsidy Criteria

A sampling of the results are shown below. The red circle shows the monthly premium at a specific LIS subsidy level -- in this case 100%. The blue circle shows whether the plan qualifies for the full LIS $0 monthly premium.

Sample of 2016 Florida Part D plans showing 100% LIS premium

As you can see in the above chart, if you receive a 100% LIS subsidy (at the bottom of the red circle), you would be charged a premium of $11.00 per month for the 2016 Florida Aetna Medicare Rx Saver plan.


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