ONECare provides access to Part D drugs at the correct LIS level when provided with evidence of LIS eligibility regardless of whether or not the health plan and Centers for Medicare & Medicaid Services (CMS) systems match. ONECare updates its system with the LIS status confirmed by the Best Available Evidence (BAE).
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 co-payment level, or, if you already have the evidence, to provide this evidence to us.
ONECare will accept the following documents as evidence of your proper co-payment level. These documents can be provided by you as a member of ONECare, by your pharmacist, advocate, representative, family member or other individual acting on your behalf, by mail or fax. Any document you submit must show that you were eligible for Medicaid during a month after June of the previous calendar year:
ONECare accepts any of the following forms of evidence to establish that a beneficiary is institutionalized and qualifies for zero cost sharing. Any document you submit must show that you were eligible for Medicaid during a month after June of the previous calendar year:
Click here for additional information about the CMS BAE policy
The late enrollment penalty is an amount added to your monthly Medicare drug plan (Part D) premium for as long as you have Medicare prescription drug coverage. This penalty is required by law and is designed to encourage people to enroll in a Medicare drug plan when they are first eligible or keep other prescription drug coverage that meets Medicare's minimum standards.
Note: If you receive "Extra Help" from Medicare to pay for your prescription drugs, the late enrollment penalty rules do not apply to you. You will not pay a late enrollment penalty, even if you go without "creditable" prescription drug coverage.
Most plans that offer prescription drug coverage, like plans from employers or unions, must send their members a notice explaining how their prescription drug coverage compares to Medicare prescription drug coverage. This notice tells you if the prescription drug coverage you had through your prior plan was "creditable prescription drug coverage," which means that it met Medicare's minimum standards. If you didn't get a separate written notice, your plan may have provided this information in its benefits handbook. If you don't know if the prescription drug coverage you had met this standard, you should contact your prior plan.
If you disagree about your late enrollment penalty, you or your representative can ask for a review of the decision about your late enrollment penalty. Generally, you must request this review within 60 days from the date on the letter you receive stating you have to pay a late enrollment penalty. Call Member Services to find out more about how to do this (number below).
If you have questions about the late enrollment penalty, call your Medicare drug plan.
You may also contact Medicare:
Medicare provides "Extra Help" to pay prescription drug costs for people who have limited income and resources. Resources include your savings and stocks, but not your home or car. If you qualify, you get help paying for any Medicare drug plan's monthly premium, yearly deductible, and prescription copayments. This Extra Help also counts toward your out-of-pocket costs.
People with limited income and resources may qualify for Extra Help. Some people automatically qualify for Extra Help and don't need to apply. Medicare mails a letter to people who automatically qualify for Extra Help.
To see if you qualify for getting Extra Help, call:
After you apply, you will get a letter letting you know if you qualify for Extra Help and what you need to do next.