LIS Information

Programs that help pay for Prescription Drugs 

“Extra Help” from Medicare. People with limited incomes may qualify for “Extra Help” to pay for their prescription drug costs. If you qualify, Medicare could pay up to seventy-five (75) percent or more of your drug costs including monthly prescription drug premiums, annual deductibles, and coinsurance. Additionally, those who qualify will not have a coverage gap or late enrollment penalty. Many people are eligible and don’t even know it. To see if you qualify, call: 

• 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048, 24 hours a day/7 days a week; 
• The Social Security Office at 1-800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday. TTY users should call, 1-800-325-0778; or 
• Your State Medicaid Office. 

Help from your state’s pharmaceutical assistance program. Virginia has a program called Virginia HIV SPAP that helps people pay for prescription drugs based on their financial need, age, or medical condition. To learn more about the program, check with your State Pharmaceutical Assistance Program (the name and phone numbers for this organization are in Chapter 2, Section 7 of the Evidence of Coverage). 

LIS Premium Summary Table

        2019 LIS Premium Summary Table

If you believe you have qualified for “Extra Help” and you believe that you are paying an incorrect cost-sharing amount when you get your prescription at a pharmacy, our plan has established a process that allows you to either request assistance in obtaining evidence of your proper copayment level, or, if you already have the evidence, to provide this evidence to us. 

You may request assistance with obtaining the best available evidence by calling Customer Service. 

• You may submit any of the following forms of evidence to Piedmont Medicare Advantage, or they can be submitted by your pharmacist, advocate, representative, family member or other individual acting on your behalf. 
  • A copy of your Medicaid card that includes your name 
  • A copy of a state document that confirms active Medicaid status 
  • A print out from the State electronic enrollment file showing Medicaid status 
  • A screen print from the State’s Medicaid systems showing Medicaid status 
  • Other documentation provided by the State showing Medicaid status 
  • A copy of the Social Security Administration award letter 
  • A remittance from the facility showing your Medicaid payment for a full calendar month 
  • A copy of a state document that confirms Medicaid payment on your behalf to the facility for a full calendar month 
  • A screen print from the State’s Medicaid systems showing your institutional status based on at least a full calendar month stay for Medicaid payment purposes 
• When we receive the evidence showing your copayment level, we will update our system so that you can pay the correct copayment when you get your next prescription at the pharmacy. If you overpay your copayment, we will reimburse you. Either we will forward a check to you in the amount of your overpayment or we will offset future copayments. If the pharmacy hasn’t collected a copayment from you and is carrying your copayment as a debt owed by you, we may make the payment directly to the pharmacy. If a state paid on your behalf, we may make payment directly to the state. Please contact Customer Service if you have questions. 

For additional information or to apply for Extra Help with Medicare Prescription Drug Plan Costs, CLICK HERE

 CMS Best Available Evidence (BAE) Policy

Piedmont Medicare Advantage is a PPO plan with a Medicare contract. Enrollment in Piedmont Medicare Advantage depends on contract renewal. Out-of-network/non-contracted providers are under no obligation to treat Piedmont Medicare Advantage members, except in emergency situations. 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.

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Last updated 01/02/2019