You may qualify for extra help paying for your Fox Rx Care prescription drug coverage.

People with limited income and resources may qualify for extra help paying for Medicare prescription drug costs.

The amount of extra help you get is based on your income, resources and level of subsidy eligibility. With such financial assistance, your Fox Rx Care monthly premium and co-payments for prescription drugs will be reduced. 

How much will my prescriptions cost me if I qualify for the extra help?

The amount of extra help you get is based on your income and resources. Prescription costs also vary based on full subsidy or partial subsidy eligibility. Here are the co-pay changes for 2008.

• Deductible $53.00
• Co-insurance 15%

If you qualify for extra help, you will have continuous drug coverage, a reduced monthly premium compared to the standard Fox Rx Care monthly premium, and a small co-payment for each prescription.

Please call our Customer Service at 1-888-FOX-RXRX (1-888-369-7979)/ 1-888-369-7373 to learn more about the program. TTY/TTD callers should use 1-866-369-7373

How is the extra help determined?

You may qualify if your annual income is less than $15,315 or $20,535 for a married couple living together, and your resources are less than $11,710 if you are single or $23, 410 if you are married and living with your spouse.*

*Income levels are for 2007, and will increase each year. Amounts will change in early 2008.The size of your family can also affect whether you qualify based on income. If you live in Alaska or Hawaii, income levels are higher.

Please call our Customer Service at 1-888-FOX-RXRX (1-888-369-7979) / 1-888-369-7373 to learn more about the program from any of our customer service team members. TTY/TTD callers should use 1-866-369-7373

How do I know if I qualify for this extra help?

You automatically qualify for extra help if you have Medicare and

• have or become eligible for Medicaid benefits
• get help from your state Medicaid program paying your Medicare premiums (you belong to a Medicare Savings Program), or
• get Supplemental Security Income (SSI) benefits without Medicaid 

How does this affect people who currently automatically qualify for extra help?

Some people who automatically qualified for extra help in 2007 will no longer automatically qualify in 2008. People who no longer have both Medicare and Medicaid (full-benefit dual-eligible’s), belong to Medicare Savings Programs (partial dual-eligible’s), or get Supplemental Security Income (SSI) benefits will no longer automatically qualify for extra help. These people will need to apply to Social Security or their State Medical Assistance (Medicaid) office to see if they still qualify for extra help based on their income and resources.

Other people will continue to automatically qualify for extra help in 2008, but their co-payment levels will change. The change in co-payment level could result from a change in their Medicaid eligibility.  For example, they may have had a change from one of the following categories to another: having Medicare and Medicaid and residing in an institution; having Medicare and Medicaid; belonging to a Medicare Savings Program; or receiving SSI benefits but not Medicaid.

People who don't have changes to their income, resources, or household size don't need to do anything.

How does this affect people who applied and qualified for extra help (i.e., those that did not automatically qualify)?

People who have any changes to their income, resources, or household size will need to return a one-page letter to Social Security within 15 days.  Social Security will then mail a form for them to fill out and return called "Social Security Administration Review of Your Eligibility for Extra Help" (Form 1026B).  If these individuals fill out and return the form within 30 days, any change to the amount of extra help they qualify for will be effective in January 2008 unless their marital status changed. Changes in marital status may result in changes to the amount of extra help in the following month. 

Social Security will also send the eligibility review form (1026B) directly to some people to complete because Social Security has information that there was a change in income or resources. This form needs to be returned within 30 days.  Social Security will review the eligibility review form (1026B) and send the person a letter explaining its decision.  Social Security may decide a person

• has no change in the amount of extra help they receive, or
• has an increase in the amount of extra help they receive, or
• has a decrease in the amount of extra help they receive, or
• no longer qualifies for extra help.

Will everyone with extra help get a letter from Medicare or Social Security?

No. People with no changes who continue to automatically qualify for extra help as of January 1, 2008, won't get a letter.

What efforts are underway affecting people who qualify for extra help paying for their Medicare prescription drug coverage?

As part of an annual process, the Centers for Medicare & Medicaid Services and the Social Security Administration are determining if people who qualify for extra help paying for Medicare prescription drug coverage in 2007 will continue to qualify in 2008.

How will people know if they no longer automatically qualify for extra help?

People who will no longer automatically qualify for extra help in 2008 received a letter from Medicare in late September. The letter includes a paper application for extra help from Social Security and a pre-addressed postage-paid envelope. These individuals can apply to see if they still qualify for extra help based on their income and resources.

What happens if I automatically qualify for extra help?

Medicare mails letters to people who automatically qualify for extra help and don’t need to apply for it. If you get one of these letters, keep it for your records. You still need to join a Medicare drug plan to get Medicare prescription drug coverage. If you don’t join a Medicare drug plan, Medicare will enroll you in one to make sure you don’t miss a day of coverage. Check to see if the plan Medicare enrolled you in covers the drugs you use and if you can go to the pharmacies you prefer. If not, you can change plans. If Medicare enrolls you in a plan, Medicare will send you a letter letting you know when your coverage begins. If you don’t want to join a Medicare drug plan (for example, because you want to keep your employer or union coverage instead), you can call 1-800-MEDICARE (1-800-633-4227) or the plan listed in your letter and tell them you don’t want to be in the Part D plan. You must be in a Medicare drug plan to get this extra help.

If you didn’t automatically qualify, but think you might qualify for extra help, here’s what to do:

1. Apply for extra help. Call Social Security at 1-800-772-1213, visit www.socialsecurity.gov on the web, or apply at your State Medical Assistance (Medicaid) office (see page 90). TTY/TTD users should call 1-800-325-0778. After you apply, you will get a letter in the mail letting you know if you qualify and what to do next. Even if you don’t qualify, you should consider joining a drug plan.

2. Join a Medicare drug plan. If you apply and qualify for extra help, you can either join a plan on your own or let Medicare enroll you in a plan. Medicare will send you a letter letting you know what plan it will enroll you in and when your coverage begins. If Medicare enrolls you in a drug plan, you can switch plans at least once through the end of the calendar year. You can also switch plans one time between November 15 and December 31 in following years. Your coverage would begin January 1 of the following year.

If I am not certain whether or not I qualify, should I apply for extra help?

Yes, because there is no risk or cost to apply. And, if you qualify, you will get extra help paying for the annual deductible, premiums, and co-payments for Medicare prescription drug coverage. Please call 1-888-Fox-RxRx (1-888-369-7979) / 1-888-369-7373 to learn more about the program from any of our customer service team members.

What information do I need to apply for the extra help?

You will need your Social Security number and financial information for you and your spouse (if married and living together), including information on deposits in bank accounts, income from pensions, investments or annuities, and face value of life insurance policies to complete the application. However, you should apply even if you think you don’t have all of this information. Please call 1-888-Fox-RxRx (1-888-369-7979)/ 1-888-369-7373 to learn more about the program from any of our customer service team members.

How often do I need to apply for the extra help?

Your eligibility will be reviewed every year to see if you still qualify for extra help. If you do qualify, you don’t need to reapply because the review will be sent to you automatically. However, if, in any year we tell you that you don’t qualify, but you think you do, you will have to reapply. Please call 1-888-Fox-RxRx (1-888-369-7979)/ 1-888-369-7373 to learn more about the program from any of our customer service team members.