Quartz Dual Eligible members

Low Income Subsidy – Extra help

Medicare offers a number of ways to help low-income members pay for their medicine. If you have Medicare and limited income and resources, you may qualify for Extra Help paying for your prescription drugs.

Extra help with Medicare prescription drug costs

If you qualify, you will not pay as much for your medications.

For more information:

  • Visit the Extra Help website (By clicking on this link, you will leave the Quartz Dual Eligible website)
  • Call Social Security at (800) 772-1213 or TTY (800) 325-0778.

If you have the necessary documentation, we can update your eligibility. Contact a Quartz Champion for help.

Where can I get more information about Best Available Evidence (BAE)?

You can visit the CMS Website. (By clicking on this link, you will leave the Quartz Dual Eligible website).

If you are a Quartz Medicare Advantage Dual Eligible with Rx member that qualifies for Part D Low Income Subsidy, please refer to the tables below.


LIS Level 3LIS Level 2LIS Level 1
Generic drugs$0$1.55$4.50
Brand/other drugs$0$4.60$11.20


Generic DrugsBrand-name Drugs
Initial Coverage Phase$0/$1.45/$4.15/$15%$0/$4.30/$10.35/$15%
Catastrophic Phase$0/$4.15$0/$10.35
Have you qualified for Extra Help but are still paying a full copayment for your medicine?

If you believe you are paying an incorrect drug copayment and you have qualified for Extra Help, we can help confirm your eligibility.*

We can help you if you have ONE of the following documents:

  1. A copy of the beneficiary’s Medicaid card (including the beneficiary’s name and eligibility date)
  2. A copy of a state document that confirms active Medicaid status
  3. A printout from the state electronic enrollment file showing Medicaid status
  4. A screen print from the state’s Medicaid system showing Medicaid status
  5. Other documentation provided by the state showing Medicaid status
  6. A letter from the Social Security Administration (SSA) showing that the individual receives Supplemental Security Income (SSI)
  7. An Important Information letter from SSA confirming that the beneficiary is “automatically eligible for extra help”
For institutionalized members

Institutionalized members may have a zero cost-sharing level. For the member to get that benefit, Quartz Dual Eligible must provide Medicare ONE or more of the following documents:

  1. A remittance from the care facility (institution); the remittance must show a Medicaid payment for a full calendar month
  2. A copy of a state document that confirms Medicaid payment to the care facility on behalf of the member for a full calendar month
  3. A screen print from the state’s Medicaid system showing the member’s institutional status, based on at least a full calendar month’s stay for Medicaid payment purposes

*Quartz Dual Eligible follows Medicare’s Best Available Evidence Policy. (By clicking on this link, you will leave the Quartz Dual Eligible website.)

Quartz Dual Eligible Drug Information

Looking for information on your drug plan? Reach out to your Quartz Champion or check your formulary (drug list).