Prescription Drug Coverage

Extra Help for Part D Drugs

Are you an Aspire Health Protect (HMO), Aspire Health Value (HMO), Aspire Health Advantage (HMO), Aspire Health Plus (HMO-POS) or Aspire Health Group Plus (HMO-POS) member or potential member with limited income and resources?

People with limited incomes may qualify for extra help to pay for their prescription drug costs: the Low Income Subsidy (LIS).

Additionally, those who qualify will not be subject to the deductible stage (if applicable), coverage gap or a late enrollment penalty. Many people are eligible for these savings and don’t even know it.

We can help you find out if you are eligible. If you qualify, you may have lower monthly premiums for the prescription drug coverage under your Aspire Health Plan. You also may have lower cost sharing for your prescriptions.

For general information about Extra Help, please call toll-free 1-800-MEDICARE (1-800-633-4227), or toll-free 1-877-486-2048 (TTY for the hearing/speech impaired), 24 hours a day, seven days a week. Or visit medicare.gov.

You also may call:

• Our Member Services department locally at (831) 574-4938 (TTY 711), or toll-free at (855) 570-1600 (TTY 711), seven days a week, 8 a.m. to 8 p.m
• Social Security toll-free at 1-800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday, or toll-free at 1-800-325-0778 (TTY for the hearing/speech impaired). Or visit the Social Security website at ssa.gov
• Your state Medi-Cal office

Apply for extra help online at ssa.gov

• 2024 Low Income Subsidy Summary (PDF):  English | Español (Coming Soon)

Best available evidence (BAE)

If you think you are eligible for Medicare’s extra help and that you are not paying the correct monthly premium or costs for your drugs, you or your appointed representative may be able to correct your Medicare records by providing us with information, known as Best Available Evidence (BAE), about your eligibility for extra help.

When we receive and verify your BAE, we will share it with Medicare and also update our records within 3 business days. You also will need to provide the information to a network pharmacy when you obtain prescriptions so that we can charge you the appropriate cost-sharing amount until Medicare updates its records to reflect your current status.

Acceptable examples of BAE documents include copies of the following.

• your state Medicaid card
• your extra help Social Security award letter
• Supplemental Security Income (SSI) Notice of Award with an effective date
• a state document that confirms your active Medicaid status
  other official state documentation showing your Medicaid status
• a Home and Community-Based Services (HCBS) Notice that includes your name and HCBS eligibility date

For members who are institutionalized or in a long-term care facility, an appointed representative can provide a copy of the following BAE examples:

• a remittance from the facility showing Medicaid payment for a full calendar month with that individual’s name on the statement
• a copy of a state document that confirms Medicaid payment to the facility for a full calendar month on behalf of the individual
• a screen printout from the state’s Medicaid information system showing that individual’s institutional status based on at least a full calendar month stay for Medicaid payment purposes

You or your appointed representative can mail a copy of your BAE document with your medical or health record number to:

Aspire Health Plan
Attn: Best Available Evidence
PO Box 5490
Salem, OR 97304

Or you may fax it locally to (831) 574-4939, toll-free at (855) 519-5769.

For more information on Low Income Subsidy and Best Available Evidence (BAE) policy, visit cms.gov.

NOTE: You must continue to pay your Medicare Part B premium. The benefit information provided is a brief summary, not a complete description of benefits. For more information contact the plan. Limitations, co-payments, and restrictions may apply. Benefits, formulary, pharmacy network, provider network, premium and/or co-payments/co-insurance may change on January 1 of each year.