CareAdvantage Cal MediConnect Plan (Medicare-Medicaid Plan)

Drug Costs

Premiums

CareAdvantage CMC members do not pay monthly premiums because the Medicare Part B premium is covered by the Medi-Cal program.

Co-payments

Avoid overchargesshow your CareAdvantage CMC member ID card to the pharmacist every time you fill a prescription.

Prescription drug co-pays range from:

  • $0, $1.25 or $3.35 for generic drugs
  • $0, $3.70 or $8.35 for brand-name drugs

The amount of your co-pay will depend on:

  • Whether you get a generic or brand-name drug
  • Your income
  • Whether you qualify for the Extra Help with Medicare Prescriptions Program
  • How much you and HPSM have already paid in the current year for your prescriptions

There is no co-payment for:

  • Drugs you receive at a nursing home facility or at a hospital
  • Some prescribed over-the-counter drugs that are covered only under the Medi-Cal part of your coverage

Extra Help Program

If you have difficulty affording co-pays, you may qualify for the Extra Help with Medicare Prescriptions Program. Depending on your income and resources, you may be eligible for $0 drug co-pays.

To apply for the Extra Help program:

  • Call the Social Security Office 1-800-772-1213 TTY: 1-800-325-0778 Hours: Monday - Friday, 7:00 a.m. to 7:00 p.m.
  • Call Medicare and ask for the Extra Help Program application: 1-800-MEDICARE (1-800-633-4227) TTY: 1-877-486-2048

How to Prove you Qualify for the Extra Help Program

If Medicare does not have current or accurate information about your income and resources, you can present your claim to be eligible through the Best Available Evidence policy.


CareAdvantage Cal MediConnect Plan (Medicare-Medicaid Plan) is a health plan that contracts with both Medicare and Medi-Cal to provide benefits of both programs to enrollees. Limitations and restrictions may apply. For more information, call the CareAdvantage Unit or read the CareAdvantage CMC Member Handbook.

Benefits and co-pays may change on January 1 of each year.

If you speak other languages other than English, language assistance services, free of charge, are available to you. Call 1-866-880-0606 (TTY: 1-800-735-2929). (Download this statement in multiple languages.)


H7885_MMP_15129_01_18_EN Approved

Page updated August 14, 2018