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Prescription
Assistance for Massachusetts
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Friendly Version
| Program Name |
Prescription Advantage |
| Phone |
1-800-243-4636 |
| Who is eligible |
Mass. residency required.
- Age 65 and over:
- With Medicare, income up to 500% FPL
- Without Medicare, no income limit.
- Under age 65:
- Individuals with disabilities who work 40 hours or fewer
per month and have incomes up to 188% FPL.
- No asset limits.
- Members/applicants with Medicare must be in Part D plan or
have creditable coverage; low-income members/applicants must
apply for low-income subsidy (LIS).
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| Where to apply |
P.O. Box 15153
Worcester , MA 01615 |
| Link to state website |
http://www.mass.gov/Eelders/docs/prescription_advantage_medicare_wrap_factsheet.pdf |
| Important Notes |
- Up to 188% FPL (including partial subsidy): pays
member’s premium for basic plan up to benchmark; limits
copays to $7 generic/$18 brand (program pays Part D
plan-required copays above these amounts). Program will pay
all member copays after actual out-of-pocket spending for
the year (TrOOP - program payments) reaches $1,300 for
members with partial subsidy and $1,440 for members with no
subsidy. Full subsidy members get assistance only with
benzodiazepines.
- 188-225% FPL: member pays up to $20 of premium, program
pays balance for basic plan up to benchmark; limits copays
to $12 generic/$30 brand. Program will pay all member copays
after actual out-of-pocket spending for the year (TrOOP -
program payments) reaches $1,800.
- 225-300% FPL: no premium subsidy; limits copays to $12
generic/$30 brand. Program will pay all member copays after
actual out-of-pocket spending for the year (TrOOP - program
payments) reaches $2,150.
- 300-500%: $200 annual enrollment fee; no premium subsidy;
full payment of Part D copays after annual out-of-pocket
spending reaches $2,870
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Top Senior
Care Concepts, 2008 |
