Low-Income Subsidy Premium Charts

Who is this for?

If you qualify for extra help paying for prescription drug coverage, you can use these charts to find out what you'll pay each month for our plans.

If you're struggling financially, you might qualify for a Low-Income Subsidy to help pay for your Medicare Part D prescription drug coverage. This is sometimes called Extra Help.

The charts below show what you'll pay each month depending on the plan you have and the level of Extra Help you get.

To read these charts, you'll need to know your plan name and what percentage of the Low-Income Subsidy you get: 100%, 75%, 50% or 25%.

Find out more about the Low-Income Subsidy and how you can get help paying for Medicare in our Help Center.

2022 plans

Plan name Low-Income Subsidy chart
BCN AdvantageSM HMO-POS and HMO plans 2022 BCN Advantage Low-Income Subsidy Table (PDF)
Medicare Plus BlueSM PPO plans 2022 Medicare Plus Blue PPO Premium Summary Table (PDF)
Prescription Blue PDPSM plans 2022 Prescription Blue PDP Select and Premium Summary Table (PDF)

2021 plans

Plan name Low-Income Subsidy chart
BCN AdvantageSM HMO-POS and HMO plans 2021 BCN Advantage Low-Income Subsidy Table (PDF)
Medicare Plus BlueSM PPO plans 2021 Medicare Plus Blue PPO Premium Summary Table (PDF)
Prescription Blue PDPSM plans 2021 Prescription Blue PDP Select, Premium and Preferred Premium Summary Table (PDF)