Help with Drug Costs

Information about Low Income Subsidy (LIS or Extra Help), EPIC/V-Pharm, and the Veteran's Administration.

 

• Low Income Subsidy ("Extra Help")

  Medicare provides "Extra Help" to help pay for prescription drug costs for Medicare eligible members who meet specific income and resource requirements.
  
  To see if you qualify, call:
  
  • Medicare at 1-800-MEDICARE (1-800-633-4227), 24 hours a day (TTY 1-877-486-2048)
  
  • Social Security Administration Office at 1-800-772-1213 (TTY 1-800-325-0778)
  
  • Your state Medicaid Office
  
  If you have both Medicare and Medicaid, you automatically qualify for Extra Help.
  
  MVP follows Medicare's Best Available Evidence policy to determine your eligibility for extra help paying for your prescription drug costs. For more information on BAE visit Medicare's Centers for Medicare & Medicaid Services (CMS) website.
  
  

• State Pharmaceutical Assistance Programs

  You may be eligible for help from the state with paying for drug coverage. This program may help you with the costs of your prescription drugs and your plan premium.
  
  To qualify, you:
  
  • Must be eligible for or already enrolled in Medicare Part D
  
  • Must live in New York State for EPIC or in Vermont for VPharm
  
  • Must meet age requirements
  
  • Must meet income requirements
  
  To learn about possible help with Part D coverage:
  
  New York: EPIC (Elderly Pharmaceutical Insurance Coverage)
  
  1-800-332-3742 (TTY 1-800-290-9138)
  
  Visit the New York State EPIC website
  
  Vermont: VPharm (Vermont Prescription Assistance)
  
  1-800-250-8427
  
  Visit the State of Vermont Green Mountain Care website
  

• Veterans Administration (VA) Coverage

  VA benefits can work together with your MVP Medicare Advantage plan. If you qualify for prescription drug benefits through the VA, you may be able to save money on your prescriptions. Call your local VA for more information.
  
  
  

 

Last updated: October 2017

Important Information

 

MVP Health Plan, Inc. is an HMO-POS/PPO/MSA organization with a Medicare contract. Enrollment in MVP Health Plan depends on contract renewal. This information is not a complete description of benefits. Contact the plan for more information. Limitations, co-payments, and restrictions may apply. Benefits, premiums and/or co-payments/co-insurance may change on January 1 of each year. You must continue to pay your Medicare Part B premium.

The Formulary, pharmacy network, and/or provider network may change at any time. You will receive notice when necessary. Medicare evaluates plans based on a 5-star rating system. Star Ratings are calculated each year and may change from one year to the next.

Out-of-network/non-contracted providers are under no obligation to treat MVP Health Plan members, except in emergency situations. For a decision about whether we will cover an out-of-network service, we encourage you or your provider to ask us for a pre-service organization determination before you receive the service. Please call our customer service number or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services. Medicare beneficiaries may also enroll in Preferred Gold HMO-POS, GoldValue HMO-POS, GoldSecure HMO-POS, Gold PPO, BasiCare PPO, and/or WellSelect PPO through the CMS Medicare Online Enrollment Center located at http://www.medicare.gov.