If you get extra help from Medicare in paying for your Medicare prescription drug plan costs, your monthly plan premium will be lower than if you did not get that extra help. The amount of extra help you get will determine your total monthly plan premium as a member of our plan. For more information on low income subsidies (LIS), visit Centers for Medicare and Medicaid Services.
2024 low-income subsidy
Our table shows you what your monthly plan premium will be if you get extra help.¹
|Plan premium with extra help applied|
|Plan name||Without extra help||100%|
|AmeriHealth Medicare Enhanced PPO||$37.30||$0.00|
|AmeriHealth Medicare Core PPO||$0.00||$0.00|
|AmeriHealth Medicare Secure PPO||$0.00||$0.00|
|AmeriHealth Medicare Ultimate PPO||$0.00||$0.00|
Additional money-saving programs in New Jersey
Here are a few programs available to help eligible members save money on prescriptions.
Pharmaceutical Assistance to the Aged & Disabled (PAAD)
The Pharmaceutical Assistance to the Aged and Disabled (PAAD) program is a state-funded program that helps eligible seniors and individuals with disabilities save money on their prescription drug costs.
Senior Gold Prescription Discount Program
The Senior Gold Prescription Discount Program (Senior Gold) is a state-funded prescription program with a different co-payment structure and income eligibility guidelines than those of PAAD.
Extra help with Medicare Part D prescription drug coverage
Extra Help is a program to assist Medicare beneficiaries in paying their monthly premiums, annual deductibles, and prescription copayments related to their Medicare Part D prescription drug coverage plan.
Medicare Savings Programs
Depending on which program you qualify for, a Medicare Savings Program will pay your Medicare premiums for Parts A and B, your Medicare deductibles, your Medicare copayments, or a combination of these expenses.
Best Available Evidence policy
Early in 2006, a number of factors contributed to the problem of incorrect cost-sharing levels for individuals eligible for Medicare and Medicaid, called full-benefit dual eligibles and other low-income (LIS) eligible individuals.
In certain situations, Centers for Medicare & Medicaid Services (CMS) systems don't reflect a beneficiary's correct low-income subsidy (LIS) status at a particular point in time. To address these situations, CMS created the Best Available Evidence (BAE) policy. This policy requires health plans to establish the appropriate cost-sharing for low-income beneficiaries when presented with evidence that the beneficiary's information is not accurate.
Learn more about the Best Available Evidence Policy, which CMS uses to determine eligibility in financial assistance programs.
¹ This does not include the Medicare Part B premium you must continue to pay. The AmeriHealth premium includes coverage for both medical services and prescription drug coverage. You may be able to get Extra Help to pay for your prescription drug premiums and costs.
To see if you qualify for extra help, call:
- 1-800-MEDICARE. TTY/TDD users call 1-877-486-2048 (24 hours a day/seven days a week)
- New Jersey Division of Medical Assistance & Health Services (Medicaid) at 1-800-701-0710 (TTY 1-800-701-0720)
- The Social Security Administration at 1-800-772-1213 (TTY/TDD: 1-800-325-0778) between 8 a.m. and 7 p.m., Monday through Friday.
If you have any questions, please call the plan at 1-866-569-5190, (TTY/TDD: 711) from 8 a.m. to 8 p.m. EST, seven days a week. Please note that on weekends and holidays from April 1 through September 30, your call may be sent to voicemail.
CMS defines brand and generic drugs based on what kind of application the drug manufacturer filed with the FDA.
- Drugs filed with a New Drug Application (NDA) are considered brand for purposes of catastrophic and LIS cost share.
- Drugs filed with an Abbreviated New Drug Application (ANDA) are considered generics.
- This will not always match up to the brand/generic formulary tier assignments defined by AmeriHealth.
Website last updated: 8/8/2023