What Passport Advantage HMO Members Pay - 2011

• A $0 deductible!
  As long as you are an active Passport Health Plan (Medicaid) member, you will not be charged a deductible because Passport Health Plan pays for it.
• A $0 charge for most covered services!
  In most cases, you will not have to pay anything for covered services if you go to a plan provider.
• A $0 monthly plan premium!
  You do not have to pay anything to join Passport Advantage - there is no plan premium!
• A $0 charge for most covered services!
  In most cases, you will not have to pay anything for covered services if you go to a plan provider.
• Very low copays for prescription drugs!
  In 2011, you will only pay $0 - $6.30 for prescription medicines if you go to a Passport Advantage pharmacy.
• No hidden copays!
  As long as you are an active Passport Health Plan member, you will have no hidden copays for covered prescriptions.

Remember: If you have an emergency, you do not need to use a Passport Advantage provider or pharmacy. Get care right away!

How can Passport Advantage be such a great value?

Passport Advantage members have low costs because Passport Advantage works together with Passport Health Plan, Kentucky Medicaid, and Medicare. To see how this works, read our Benefits Chart. You can also read more about what services we cover and what you pay for them.

Things you need to know about what you pay based on your Low Income Subsidy (LIS) status or amount of "Extra Help":

• You pay a $0 monthly plan premium as long as you get the highest amount of extra help from Medicare to pay for your prescription medicines.
• If you lose some, or all, of the extra help that Medicare gives to you for prescription medicines, you will have to pay more. You might have to pay a monthly plan premium, and a deductible, and higher co-insurance when you fill prescriptions.
• Kentucky Medicaid pays the Part B premium for Passport Advantage members. Limitations, copayments, and restrictions may apply. You may be able to get Extra Help to pay for your prescription drug premium and costs. To see if you qualify for Extra Help, call:
  • 1-800-MEDICARE (1-800-633-4227). TTY or TDD 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 or TDD users should call 1-800-328-0778; or
  • Your State Medicaid Office at 1-800-635-2570.
• If you do not get premium-free Medicare Part A, you or Kentucky Medicaid must continue your Medicare Part A premium.
• If Kentucky Medicaid takes you out of both Passport Health Plan and Kentucky Medicaid, you will have to pay your providers for the amounts that Passport Advantage does not cover.
• In 2011, once you and Passport Advantage have paid $4,550 toward your prescription drug benefit in a calendar year, you will not have to pay any more co-payments for the rest of that calendar year.