Do you get Extra Help from Medicare?

1971335 Y0114_18_31544_X_001 2018 LIS Premium Chart AGP 09 17 Do you get Extra Help from Medicare? Here s what your monthly payment will be for 2018 If you get Extra Help from Medicare to pay your Medicare prescription drug plan costs, your monthly payment will be lower than what it would be if you paid it all on your own. The amount of Extra Help you get will determine your total monthly payment as a member of our plan. The table below shows how much your monthly payment will be in 2018 based on your state, county and the percentage of Extra Help you receive. This does not include any Medicare Part B payment you may have. New Jersey Atlantic, Bergen, Burlington, Camden, Cumberland, Essex, Gloucester, Hudson, Mercer, Middlesex, Monmouth Morris, Ocean, Passaic, Somerset, Union Amerivantage Dual Coordination (HMO SNP) Your After Extra Help $36.00 $0.00 $9.00 $18.00 $27.00

Amerivantage Dual Coordination (HMO DSNP) is an HMO DSNP plan with a Medicare contract and a contract with the New Jersey Medicaid program. Enrollment in Amerivantage Dual Coordination (HMO DSNP) depends on contract renewal. If you aren t getting Extra Help, you can see if you qualify by calling: If you have any questions, please call Customer Service at 1-844-765-5160, TTY: 711, 8 a.m. to 8 p.m., seven New Jersey Bergen, Essex, Hudson, Middlesex, Monmouth, Ocean, Passaic, Somerset, Union Amerivantage ESRD (HMO-POS SNP) Your After Extra Help $36.00 $0.00 $9.00 $18.00 $27.00

Amerivantage is an HMO/POS CSNP plan with a Medicare contract. Enrollment in Amerivantage depends on contract renewal. If you aren t getting Extra Help, you can see if you qualify by calling: If you have any questions, please call Customer Service at 1-844-887-6350, TTY: 711, 8 a.m. to 8 p.m., seven New Jersey Bergen, Hudson, Union Amerivantage Balance (HMO) Your After Extra Help $37.00 $1.00 $10.00 $19.00 $28.00 Amerivantage (HMO) is an HMO plan with a Medicare contract. Enrollment in Amerivantage (HMO) depends on contract renewal.

New Mexico Bernalillo, Sandoval, Santa Fe, Torrance, Valencia Amerivantage Classic (HMO) Your After Extra Help $24.60 $0.00 $6.10 $12.30 $18.40 Amerigroup Community Care of New Mexico, Inc. is an HMO plan with a Medicare contract. Enrollment in Amerigroup Community Care of New Mexico, Inc. depends on contract renewal.

Tennessee Anderson, Bedford, Benton, Bledsoe, Blount, Bradley, Campbell, Cannon, Carroll, Carter, Cheatham, Chester, Claiborne, Clay, Cocke, Coffee, Crockett, Cumberland, Davidson, Decatur, DeKalb, Dickson, Dyer, Fayette, Fentress, Franklin, Gibson, Giles, Grainger, Grundy, Hamblen, Hamilton, Hancock, Hardeman, Hardin, Hawkins, Haywood, Henderson, Henry, Amerivantage Dual Coordination (HMO SNP) Your After Extra Help $30.60 $0.00 $7.60 $15.30 $22.90

Hickman, Houston, Humphreys, Jackson, Jefferson, Johnson, Knox, Lake, Lauderdale, Lawrence, Lewis, Lincoln, Loudon, Macon, Madison, Marion, Marshall, Maury, McNairy, Meigs, Monroe, Montgomery, Moore, Morgan, Obion, Overton, Perry, Pickett, Polk, Rhea, Roane, Robertson, Rutherford, Scott, Sequatchie, Sevier, Shelby, Smith, Stewart, Sullivan, Sumner, Tipton, Trousdale, Unicoi, Union, Van Buren, Warren, Washington, Wayne, Weakley, White, Williamson, Wilson Amerigroup Tennessee, Inc. is an HMO DSNP plan with a Medicare contract and a contract with the State Medicaid program. Enrollment in Amerigroup Tennessee, Inc. depends on contract renewal. If you aren t getting Extra Help, you can see if you qualify by calling: If you have any questions, please call Customer Service at 1-877-411-0929, TTY: 711, 8 a.m. to 8 p.m., seven

Tennessee Benton, Cannon, Cheatham, Claiborne, Clay, Davidson, Decatur, DeKalb, Dickson, Dyer, Fayette, Fentress, Gibson, Giles, Hamilton, Hardin, Henry, Hickman, Houston, Jackson, Jefferson, Knox, Lawrence, Lewis, Lincoln, Macon, Marshall, Maury, McNairy, Meigs, Montgomery, Overton, Perry, Polk, Robertson, Rutherford, Shelby, Stewart, Sumner, Tipton, Van Buren, Warren, Wayne, White, Williamson, Wilson Amerivantage Classic (HMO) Your After Extra Help $0.00 $0.00 $0.00 $0.00 $0.00 Amerigroup Tennessee, Inc. is an HMO plan with a Medicare contract. Enrollment in Amerigroup Tennessee, Inc. depends on contract renewal. If you aren t getting Extra Help, you can see if you qualify by calling:

Tennessee Anderson, Bedford, Bledsoe, Blount, Bradley, Campbell, Cocke, Coffee, Cumberland, Franklin, Grainger, Grundy, Hancock, Hawkins, Humphreys, Lauderdale, Loudon, Marion, Monroe, Moore, Morgan, Obion, Pickett, Rhea, Roane, Scott, Sequatchie, Sevier, Smith, Sullivan, Trousdale, Unicoi, Union, Washington, Weakley Amerivantage Classic (HMO) Your After Extra Help $27.00 $0.00 $6.70 $13.50 $20.20 Amerigroup Tennessee, Inc. is an HMO plan with a Medicare contract. Enrollment in Amerigroup Tennessee, Inc. depends on contract renewal.

Tennessee Shelby Amerivantage Plus (HMO) Your After Extra Help $0.00 $0.00 $0.00 $0.00 $0.00 Amerigroup Tennessee, Inc. is an HMO plan with a Medicare contract. Enrollment in Amerigroup Tennessee, Inc. depends on contract renewal.

Texas Bexar, El Paso, Fort Bend, Harris, Jefferson, Montgomery, Travis Amerivantage Select (HMO) Your After Extra Help $0.00 $0.00 $0.00 $0.00 $0.00 Amerigroup Texas, Inc. is an HMO plan with a Medicare contract. Enrollment in Amerigroup Texas, Inc. depends on contract renewal.

Texas Bexar, Comal, Crosby, Dallas, Denton, El Paso, Floyd, Fort Bend, Galveston, Garza, Hale, Harris, Hays, Hockley, Hudspeth, Jefferson, Lamb, Lubbock, Lynn, Medina, Montgomery, Tarrant, Terry, Travis, Williamson Amerivantage Classic (HMO) Your After Extra Help $0.00 $0.00 $0.00 $0.00 $0.00 Amerigroup Texas, Inc. is an HMO plan with a Medicare contract. Enrollment in Amerigroup Texas, Inc. depends on contract renewal.

Texas Fort Bend, Galveston, Harris, Jefferson, Montgomery, Dallas, Denton, Tarrant, Bexar, Comal, Medina, El Paso, Hudspeth, Crosby, Floyd, Garza, Hale, Hockley, Lamb, Lubbock, Lynn, Terry, Hays, Travis, Williamson Amerivantage Dual Coordination (HMO SNP) Your After Extra Help $24.60 $0.00 $6.20 $12.30 $18.50 Amerigroup Texas, Inc. is an HMO DSNP plan with a Medicare contract and a contract with the State Medicaid program. Enrollment in Amerigroup Texas, Inc. depends on contract renewal.

Texas Bexar, Comal, El Paso, Hays, Travis, Williamson Amerivantage ESRD (HMO-POS SNP) Your After Extra Help $16.00 $0.00 $4.00 $8.00 $12.00 Amerigroup Texas, Inc. is an HMO CSNP plan with a Medicare contract. Enrollment in Amerigroup Texas, Inc. depends on contract renewal.

If you have any questions, please call Customer Service at 1-877-269-5660, TTY: 711, 8 a.m. to 8 p.m., seven Texas Fort Bend, Harris, Jefferson Amerivantage Dual Premier (HMO SNP) Your After Extra Help $24.60 $0.00 $6.20 $12.30 $18.50 Amerigroup Texas, Inc. is an HMO CSNP plan with a Medicare contract. Enrollment in Amerigroup Texas, Inc. depends on contract renewal.

If you have any questions, please call Customer Service at 1-844-765-5165, TTY: 711, 8 a.m. to 8 p.m., seven Washington King, Snohomish Amerivantage Classic (HMO) Your After Extra Help $0.00 $0.00 $0.00 $0.00 $0.00 Amerigroup Washington, Inc. is an HMO plan with a Medicare contract. Enrollment in Amerigroup Washington, Inc. depends on contract renewal.

Washington King, Snohomish Amerivantage Dual Coordination (HMO SNP) Your After Extra Help $34.60 $0.00 $8.70 $17.30 $26.00 Amerigroup Washington, Inc. is an HMO DSNP plan with a Medicare contract and a contract with the State Medicaid program. Enrollment in Amerigroup Washington, Inc. depends on contract renewal.

If you have any questions, please call Customer Service at 1-844-812-2275, TTY: 711, 8 a.m. to 8 p.m., seven Y0114_18_31544_X_001 68817MUSENAGP_001