Superior Select Health Plans

A Partnership for Care

Need Help? Call Member Services at 1-877-372-1033 (TTY 711) 8 a.m. - 8 p.m. | 7 days a week
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Superior Select Health Plans

Monthly Plan Premium for People who get Extra Help from Medicare
to Help Pay for their Prescription Drug Costs

If you get extra help from Medicare to help pay for your Medicare prescription drug plan costs, your monthly plan premium will be lower than what it would be if you did not get extra help from Medicare. The amount of extra help you get will determine your total monthly plan premium as a member of our Plan.

This table shows you what your monthly plan premium will be if you get extra help.

Your level of extra help Monthly Premium for Tribute HMO-POS SNP* Monthly Premium for Horizons HMO-POS* Monthly Premium for Select HMO-POS SNP*
100% $0 $0 $105.40
75% $5.70 $5.70 $111.00
50% $11.30 $11.30 $116.70
25% $17.00 $17.00 $122.30

*This does not include any Medicare Part B premium you may have to pay.

Superior Select Health Plan’s premium includes coverage for both medical services and prescription drug coverage.

If you aren’t getting extra help, you can see if you qualify by calling:

  • 1-800-Medicare of TTY users call 1-877-486-2048 (24 hours a day/7 days a week),
  • Your State Medicaid Office, or
  • The Social Security Administration at 1-800-772-1213. TTY users should call 1-800-325-0778 between 7 a.m. and 7 p.m., Monday through Friday.

If you have any questions, please call Member Service at 1-877-372-1033, (TTY: 711) from 8 a.m. to 8 p.m., 7 days a week.

Last Updated: Dec 1, 2017 @ 10:08 am

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