Extra Help

When You Need Extra Help

Some people with limited resources and income also may be able to get “Extra Help” to pay for the costs of a Medicare prescription drug plan, including monthly premiums, annual deductibles and prescription co-payments.

If you believe that your cost-sharing amount for any prescriptions is incorrect, Provider Partners Health Plans can help you:

• Request help to obtain evidence of your proper copay level, or
• If you already have the evidence, to provide this evidence to us.

As a Part D plan sponsor, CMS regulations require us to have a process to help you determine if you are eligible for the Low Income Subsidy (LIS) when some of your documentation is missing or there is a conflict between the CMS system and your actual status.

Before you enroll, Provider Partners Health Plans will tell you what your plan premium will be with a low-income subsidy.

Provider Partners Health Plans accepts the following forms of evidence to establish the subsidy status of a beneficiary that is institutionalized and qualifies for zero cost-sharing:

• Documentation from the facility showing Medicaid payments for a full calendar month
• Documentation from the state that confirms Medicaid payment to the facility for a full calendar month
• A screen print from State Medicaid showing the institutional status based on a full calendar month stay for Medicaid payment purposed

Provider Partners Health Plans accepts the following forms of evidence to establish the subsidy status of a dual eligible individual:

• A copy of valid State Medicaid Card showing eligibility dates
• Complete documentation of contact with State Medicaid verifying the Medicaid status (including date and time of contact, name, title, and phone number of the person contacted)
• Documentation that confirms active Medicaid status
• A printout from the State electronic enrollment file showing Medicaid status
• A screen print from the State’s Medicaid systems showing Medicaid status
• Other documentation provided by the State showing Medicaid status

These documents may be mailed to Provider Partners Health Plans’ main office:

Provider Partners Health Plans
PO BOX 26289
Tampa, FL 33623