Low Income Subsidy and Best Available Evidence

Monthly Plan Premium for People who get Extra Help from Medicare to Help Pay for their Prescription Drug Costs.

If you get extra help from Medicare to help pay for your Medicare prescription drug plan costs, your monthly plan premium will be lower than what it would be if you did not get extra help from Medicare. The amount of extra help you get will determine your total monthly plan premium as a member of our Plan.

This table shows you what your monthly plan premium will be if you get extra help.

2020 LIS Table
Your Level of Extra Help Monthly Premium for Experience Health Medicare AdvantageSM (HMO)
100% $0.00
75% $5.00
50% $10.00
25% $15.00

*This does not include any Medicare Part B premium you may have to pay.

Experience Health Medicare Advantage (HMO) premium includes coverage for both medical services and prescription drug coverage.

If you aren't getting extra help, you can see if you qualify by calling:

  • Your State Medicaid Office, or

  • The Social Security Administration at 1-800-772-1213.
    TTY users should call 1-800-325-0778 between 7 a.m. and 7 p.m., Monday through Friday.

In certain cases, CMS systems do not reflect a beneficiary's correct low-income subsidy (LIS) status at a particular point in time. As a result, the most up-to-date and accurate subsidy information has not been communicated to the Part D plan.

To address these situations, CMS created the best available evidence (BAE) policy in 2006. This policy requires sponsors to establish the appropriate cost-sharing for low-income beneficiaries when presented with evidence that the beneficiary's information is not accurate.

Please click on the link to CMS website below for materials related to the CMS Best Available Evidence (BAE) policy.

View Policy