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)|
Note: The premiums listed above do not include any Medicare Part B premium you may have to payView 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|
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.