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 chart below shows how the Extra Help program can help you with your prescription drug costs.
| Qualifying Categories | Your monthly plan premium is | Your yearly deductible is | Your cost-sharing amount for generic/preferred multi-source drugs is no more than | Your cost-sharing amount for all other drugs is no more than |
| Institutional status or receiving Community-based services | $0 | $0 | $0 | $0 |
| Individuals at 100% FPL* | $0 | $0 | $1.65 | $5.00 |
| Individuals between 100% and 150% FPL | $0 | $0 | $5.80 | $14.40 |
| Individuals above 150% FPL and do not qualify for Extra Help or Medicaid | $2.60 – $7.30^ | $700 | $0 (Tiers 1, 2 and 6)
25% of total cost (Tiers 3, 4 and 5) |
$0 (Tiers 1, 2 and 6)
25% of total cost (Tiers 3, 4 and 5) |
*FPL means federal poverty level
^Depending on plan
Champion Health Plan’s premium includes coverage for both medical services and prescription drug coverage. Call our Member Services department at 1-800-885-8000 ( TTY: 711) 8:00 a.m. to 8:00 p.m., 7 days a week from October 1 – March 31 (except Thanksgiving and Christmas Day) and 8:00 a.m. to 8:00 p.m. Monday – Friday from April 1 – September 30 if you have questions. This call is free.
If you aren’t getting Extra Help, you can see if you qualify by calling:
