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2021 urgent care copay rates; Priority group Copay amount for first 3 visits in each calendar year Copay amount for each additional visit in the same year; Priority group: 1 to 5: Copay amount for first 3 visits in each calendar year: $0 (no copay) Copay amount for each additional visit in. 2021 Extra Help/LIS copay levels & costs (Income amounts will be updated approx. 2021 to reflect 2021 FPLS) People on these programs are “deemed” eligible for LIS – they don’t need to apply! Beneficiary group Monthly income. Monthly premium. Annual deductible. Total covered spending.
Monthly premium
Subsidy Levels | Complete | Complete Plus | Standard | Standard Plus | Dual Care |
---|---|---|---|---|---|
Level 1 - 100% | $0 | $93.90 | $8.90 | $133.90 | $0 |
Level 2 - 100% | $0 | $93.90 | $8.90 | $133.90 | $0 |
Level 3 - 100% | $0 | $93.90 | $8.90 | $133.90 | $0 |
Level 4 - 100% | $0 | $93.90 | $8.90 | $133.90 | $0 |
Level 4 - 75% | $0 | $101.70 | $16.70 | $141.70 | $6.00 |
Level 4 - 50% | $0 | $109.40 | $24.40 | $149.40 | $12.00 |
Level 4 - 25% | $0 | $117.20 | $32.20 | $157.20 | $18.00 |
- 2021 Drug Cost Sharing Stages for Beneficiaries with Extra Help (LIS) LIS-Note 1 Deductible Initial Coverage Catastrophic-Note 2 Level 1 None Copays no more than $3.70 for generic and $9.20 for brand name drugs No copay Level 2 None Copays no more than $1.30 for generic and $4.00 for brand name drugs Level 3 None No copay Level 4 $92.
- If a Silver plan's copayment is $30 for a doctor's visit, if you enroll in the plan and qualify for extra savings, you may pay $20 or $15 instead. You'll have a lower 'out-of-pocket maximum.' This means the total amount you'd have to pay in a year if you used a lot of care, like if you got seriously sick or had an accident, would be lower.
Out-of-pocket drug costs
Subsidy Levels | Annual Deductible Complete, Standard, and Dual Care | Annual Deductible Complete Plus and Standard Plus | Copayment / Coinsurance* | Catastrophic Copayment** |
---|---|---|---|---|
Level 1 - 100% | $0 | $0 | $3.70/$9.20 | $0/$0 |
Level 2 - 100% | $0 | $0 | $1.30/$4 | $0/$0 |
Level 3 - 100% | $0 | $0 | $0/$0 | $0/$0 |
Level 4 - 100% | $92 | $0 | 15% | $3.70/$9.20 |
Level 4 - 75% | $92 | $0 | 15% | $3.70/$9.20 |
Level 4 - 50% | $92 | $0 | 15% | $3.70/$9.20 |
Level 4 - 25% | $92 | $0 | 15% | $3.70/$9.20 |
* Copayment amounts for generic/preferred multi-source and other drugs, respectively. For example, the first amount shown ($3.70) is the copayment for a generic drug filled for a member in the LIS Category 1.
** After the true-out-of-pocket limit is reached, the Catastrophic copayment for LIS Levels 1, 2, and 3 is $0 for both generic and brand drugs. The Catastrophic copayments for LIS Level 4 are $3.70 for generic/preferred multi-source drugs and $9.20 for other drugs.
You must continue to pay your Medicare Part B premium.
Extra Help Copays 2021 List
Medicare Extra Help Copays 2021
HMSA Disclaimer
Extra Help Copays 2021 Application
- HMSA Akamai Advantage is a PPO plan with a Medicare contract. Enrollment in HMSA Akamai Advantage depends on contract renewal.