MetroPlus Medicare Extra Help Monthly Plan Premium Chart
If you get extra help from Medicare to help pay for your Medicare prescription drug plan costs, your monthly plan premium will be lower than what it would be if you did not get extra help from Medicare. The amount of extra help you get will determine your total monthly plan premium as a member of our Plan.
This table shows you what your monthly plan premium will be if you get extra help.
|
Your level of extra help |
2012 Monthly Premium for MetroPlus Advantage(HMO SNP)* |
100% |
$0 |
|
75% |
$8.55 |
|
50% |
$17.10 |
25% |
$29.03 |
This table shows you what your monthly plan premium will be if you get extra help.
|
Your level of extra help |
2012 Monthly Premium for MetroPlus Partnership In Care Plan (HMO SNP)* |
100% |
$0 |
|
75% |
$5.90 |
|
50% |
$11.85 |
25% |
$17.75 |
This table shows you what your monthly plan premium will be if you get extra help.
|
Your level of extra help |
2012 Monthly Premium for MetroPlus Platinum Plan (HMO)* |
100% |
$11.50 |
|
75% |
$12.80 |
|
50% |
$25.65 |
25% |
$38.50 |
* This does not include any Medicare Part B premium you may have to pay. This premium includes coverage for both medical services and prescription drug coverage.
If you aren't getting extra help, you can see if you qualify by calling:
• 800-Medicare or TTY 877-486-2048, 24 hours a day/7 days a week,
• Your State Medicaid Office, or
• The Social Security Administration at 800-772-1213 or TTY 800-325-0778 from 7 am to 7 pm, Monday through Friday.
If you have any questions, please call MetroPlus Customer Service at 866-986-0356, TTY 800-881-2812, Monday through Saturday from 8 am to 8 pm.
H0423_MKT1004v3 CMS APPROVED 10122011
