Advantage D-SNP Medicare Programs for Financial Help

Being able to pay your drug costs in smaller monthly payments instead of all at once at the pharmacy can help some people with Medicare Part D. This option makes it easier to afford your medicines by spreading out the costs over the year. Anyone with Medicare Part D can use this program, but it helps most those who have to pay a lot for their medicines early in the year.

If you have Medicare Part D and qualify for Extra Help (also called the Low-Income Subsidy or LIS), then the LIS program may save you more money than the Medicare Prescription Payment Plan.

Extra Help lowers the cost of your prescription drugs and helps pay for your Medicare drug coverage.

Many people can get Extra Help and don’t even know it!

To learn more:

• Visit Medicare.gov/basics/costs/help
• Or contact your local Social Security office at ssa.gov/locator/

You may qualify for a program that helps pay for your medicine!

This program does not lower the total amount you pay for your medicine. Instead, it helps you spread out the cost over time so you don’t have to pay all at once.

Here’s how it works:

• You pay $0 at the pharmacy when you pick up your covered Medicare Part D drugs.
• Health Plan of San Joaquin/Mountain Valley Health Plan Advantage D-SNP (through MedImpact) will send you a bill every month for the amount you owe.
• The amount you owe each month may change, depending on how many new prescriptions you get.
• Your monthly bill will include:
  1. What you would normally pay for new prescriptions that month,
  2. Any unpaid balance from the month before,
  3. Divided by the number of months left in the year.

The total amount you pay over the year will not be more than your Medicare Part D out-of-pocket maximum.

Health Plan of San Joaquin/Mountain Valley Health Plan Advantage D-SNP contracts with MedImpact who will send you a bill every month. You pay the bill directly following the instructions in the bill. You can also access your bills and make payments by logging into your Part D Member Portal.

If you have Medicare Part D and qualify for Extra Help (also called the Low-Income Subsidy or LIS), then the LIS program may save you more money than the Medicare Prescription Payment Plan.

Extra Help lowers the cost of your prescription drugs and helps pay for your Medicare drug coverage.

Many people can get Extra Help and don’t even know it!

To learn more:

• • Visit Medicare.gov/basics/costs/help
  • Or contact your local Social Security office at ssa.gov/locator/

You may qualify for a program that helps pay for your medicine!

You (or someone allowed to speak for you) can sign up for the Medicare Prescription Payment Plan:

• Before the new plan year starts
• Anytime during the year
• During:
  1. The Annual Enrollment Period (plan effective date is January 1 of the next year)
  2. Your Initial Enrollment Period (plan effective date is the month you turn 65 years old or the 1^st of the following month if you do not enroll until after you have turned 65 years old)
  3. A Special Enrollment Period (plan effective date varies, usually it is the 1^st of the following month, call us to see if this applies to you)

You can enroll in the program:

• By mail (fill out a paper form and send it in):

Health Plan of San Joaquin/Mountain Valley Health Plan
Attention: MPPP Enrollment
7751 South Manthey Road
French Camp, CA 95231

• By phone (MedImpact): 1-833-546-0796, 24 hours a day, 7 days a week
• On our website: (Coming Soon 10/15/2025)

If you have questions or need help signing up, you can also contact us at 1-888-361-7526 (TTY 711) from 8:00 a.m. to 8:00 p.m., seven days a week from October 1 through March 31, and Monday to Friday from April 1 through September 30. The call is free.

When you ask to join the Medicare Prescription Payment Plan, here is what you can expect to happen next:

1. We Will Review Your Request Quickly

After we get your request to join, we will review it and send you a letter or notice. The time we have to respond depends on when you sign up:

• If you sign up prior to the plan year or submit an incomplete election request form:
  We must send you a decision within 10 calendar days.
• If you sign up during the plan year:
  We must send you a decision within 24 hours.

2. If Your Request Is Approved

• We will send you a letter that tells you when your plan will start letting you pay your prescription drug costs in monthly payments.
• This start date is called the effectuation date.
• The effectuation date will be either:
  • The first day of the next month after you sign up, or
  • Another date we tell you in your approval letter.
• We will also call you to let you know your effectuation date, unless you requested to enroll through a telephone call and your effectuation date as well as the terms and conditions were already provided to you at the same time.

3. If We Need More Information

• We will send you a letter asking for more details or documents to complete your request.
• You will have 21 days from the date on the letter to send us the information we asked for.
• If we don’t get the information in time, your request to join the program may be denied.

4. If Your Request Is Denied

• We will send you a letter explaining why your request was denied.
• This letter will also explain how you can ask us to review the decision if you disagree.

What Will You Get in the Mail?

After you sign up, you will get important letters that:

• Confirm your request was received,
• Tell you if you are approved or need to send more information,
• Explain your effectuation date (when you start the program), and
• If denied, tell you why and what to do next.

If you have questions at any time, please call 1-888-361-7526 (TTY 711) from 8:00 a.m. to 8:00 p.m., seven days a week from October 1 through March 31, and Monday to Friday from April 1 through September 30. The call is free.  We’re here to help you!

We want to make sure you’re happy with your Medicare Prescription Payment Plan. If you have a problem or a concern about the plan, how it works, or how you were treated, you can file a grievance or dispute. We will listen to you and work to fix the issue.

What Is a Grievance?

A grievance is a complaint. You might file a grievance if:

• You are not happy with the service you received
• You had trouble enrolling or making a payment
• You were treated unfairly or rudely
• You had trouble getting information from us

Note: A grievance is not the same as asking us to pay for a drug or service. That is called a coverage determination or appeal.

How to File a Grievance

You must file your grievance within 60 days of when the problem happened.

You can file a grievance in these ways:

• By phone: 1-888-361-7526 (TTY 711) from 8:00 a.m. to 8:00 p.m., seven days a week from October 1 through March 31, and Monday to Friday from April 1 through September 30
• By mail:

Grievance
7751 South Manthey Road
French Camp CA, 95231

• Online: (Coming Soon 10/15/2025)

We will look into your concern and respond:

• Within 30 days, or
• Faster, if waiting that long could harm your health

What Is a Dispute?

A dispute happens when you disagree with something about your bills or payments under the Medicare Prescription Payment Plan. For example, if you think you were charged the wrong amount.

You or someone you choose (like a family member or legal representative) can file a dispute with us.

How to File a Dispute

You can send your dispute:

• By phone: 1-888-361-7526 (TTY 711) from 8:00 a.m. to 8:00 p.m., seven days a week from October 1 through March 31, and Monday to Friday from April 1 through September 30
• By mail:

Dispute
7751 South Manthey Road
French Camp CA, 95231

• Online: (Coming Soon 10/15/2025)

We’ll review your request and let you know our decision as quickly as possible, but no later than 30 days after we receive it.

Need Help?

If you don’t understand your rights or need help filing a grievance or dispute, we can help.

Call us at 1-888-361-7526 (TTY 711)
Hours: 8:00 a.m. to 8:00 p.m., seven days a week from October 1 through March 31, and Monday to Friday from April 1 through September 30.