Low-Income Subsidy - Community Health Plan of Washington - Medicare Advantage

Low-Income Subsidy

The Low-Income Subsidy (LIS) Program, also known as Extra Help, can lower your monthly premium by helping pay for your Medicare Prescription drug plan costs.

2022 Low-Income Subsidy (Extra Help) Premiums

This table shows what your monthly plan premium will be depending on your level of extra help. CHPW Medicare Advantage premiums listed are for both medical services and prescription drug benefits.

Your level of Extra Help MA DUAL PLAN (HMO SNP) MA PLAN 2 (HMO) MA PLAN 3 (HMO) MA PLAN 4 (HMO)
100% $0.00 $0.00 $27.50 $53.50
75% $10.10 $10.10 $37.60 $63.60
50% $20.20 $20.30 $47.80 $73.80
25% $30.30 $30.40 $57.90 $83.90

Note: The premiums listed above do not include any Medicare Part B premium you may have to pay

View 2021 Low-Income Subsidy Premiums

2021 Low-Income Subsidy Premiums

These tables show you what your monthly plan premium will be depending on your level of extra help.

Your level of extra help MA PLAN 3 (HMO) 008 MA PLAN 4 (HMO) 009 MA PLAN 2 (HMO) 010 MA DUAL PLAN (HMO SNP) 014
100% $0.00 $0.00 $0.00 $0.00
75% $8.70 $5.50 $6.60 $9.00
50% $17.50 $11.00 $13.20 $18.00
25% $26.20 $16.50 $19.90 $27.00

The premiums listed above do not include any Medicare Part B premium you may have to pay. CHPW Medicare Advantage premiums listed are for both medical services and prescription drug benefits.

Learn More About Extra Help

How to Apply for Extra Help

See if you qualify by contacting:

  • Medicare: 1-800-MEDICARE (TTY: 1-877-486-2048), 24 hours a day/7 days a week
  • Washington State DSHS: 1-800-737-0617 (TTY:711 or 1-800-833-6388)
  • Social Security: 1-800-772-1213 (TTY: 1-800-325-0778), 7:00 a.m. – 7:00 p.m., Monday through Friday

Best Available Evidence Requirement

If you believe you qualify for Low-Income Subsidy (LIS) and are paying the incorrect cost-sharing amount, we can help. Over the phone or at your local clinic, we can:

  • Review your eligibility
  • Guide you through the process of obtaining evidence of your proper co-payment level
  • Help you fill out the necessary forms

Contact us for assistance at 1-800-942-0247 (TTY Relay: 711), 8 a.m. to 8 p.m., seven days a week.

Read our Best Available Evidence Requirement (BAE) policy here. We follow the Centers for Medicare & Medicaid Services (CMS) BAE to determine a member’s Low-Income Subsidy. Acceptable forms of evidence are:

  • Your State Medicaid ID Card
  • Other evidence from the state showing that you are Medicaid eligible
  • SSA letter that shows your Supplemental Security Income (SSI) effective date
  • SSA award letter that says you are automatically eligible for Extra Help

To submit BAE documentation, members may:

  • Mail to:
    Community Health Plan of Washington
    Attn: Medicare Advantage
    1111 Third Avenue, Suite 400
    Seattle, WA 98101
  • Fax to 1-206-652-7050
  • Call 1-800-942-0247 (TTY Relay: 711) for assistance

As soon as one of the forms of BAE is presented, we will update our system so you can pay the correct copayment when you get your next prescription at the pharmacy.

CHPW Medicare Advantage is an HMO plan with a Medicare contract. Enrollment in CHPW Medicare Advantage depends on contract renewal. The benefit information provided is a brief summary, not a complete description of benefits. For more information, contact us.

DID YOU KNOW...?

Stay on Top of Your Prescriptions

Woman grabbing a prescriptionDid you know that certain prescription medicines are available as a 90-day supply? Medicine that you take on a long-term basis to manage your health is called a “maintenance drug.” A 90-day supply makes it easier to keep taking the medicine you need to feel your best. You may also be eligible to receive your long-term medications through free home delivery.

LEARN MORE

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