Extra Help & Best Available Evidence (BAE)
Individuals with limited income and resources may qualify for extra help to pay for their
prescription drug costs. Resources include your savings and stocks, but do not include your
home or car. If you qualify, Medicare could pay for 75% or more of your drug costs including
monthly prescription drug premiums, annual deductibles, and co-insurance. If Medicare pays
only a portion of this premium, we will bill you for the amount that Medicare doesn’t cover.
You can see if you qualify by calling:
- 1-800-Medicare or TTY users call 1-877-486-2048 (24 hours a day/7 days a week).
- Your State Medicaid Office.
- 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.
You can apply for extra help at: https://www.socialsecurity.gov/prescriptionhelp or by calling 1-
800-772-1213 (TTY 1-800-325-0778).
Your extra help status can also be provided to Zing Health by submitting Best Available
Evidence. Best Available Evidence (BAE) is a document that shows you qualify for Extra Help
with your prescription drug costs. Listed below are a examples of BAE documents that are
accepted by Medicare:
- A copy of the member’s Medicaid card which includes the member’s name and an
eligibility date during the discrepant period;
- A report of contact including the date a verification call was made to the State Medicaid
Agency and the name, title and telephone number of the state staff person who verified
the Medicaid status during the discrepant period;
- A copy of a state document that confirms active Medicaid status during the discrepant
- A print out from the State electronic enrollment file showing Medicaid status during the
- A screen print from the State’s Medicaid systems showing Medicaid status during the
discrepant period; or
- Other documentation provided by the State showing Medicaid status during the
In addition, Zing Health will accept any one of the following forms of evidence from
beneficiaries or pharmacists to establish that a beneficiary is institutionalized and qualifies for
- A remittance from the facility showing Medicaid payment for a full calendar month for
that individual during the discrepant period;
- A copy of a state document that confirms Medicaid payment to the facility for a full
calendar month on behalf of the individual; or
- A screen print from the State’s Medicaid systems showing that individual’s institutional
status based on at least a full calendar month stay for Medicaid payment purposes
during the discrepant period.
For more information on “Extra Help” and examples of BAE documents, please refer to Chapter
2, Section 7 of your Evidence of Coverage.
Fax or mail BAE documents to:
ATTN: Enrollment Department
303 West Madison Street, Suite 800
Chicago, IL 60606
When we receive the evidence showing your copayment level, we will update our system so
that you can pay the correct copayment when you get your next prescription at the pharmacy.
If you overpay your copayment, we will reimburse you. We will forward a check to you in the
amount of your overpayment or we will offset future copayments. If the pharmacy hasn’t
collected a copayment from you and is carrying your copayment as a debt owed by you, we
may make the payment directly to the pharmacy. If a state paid on your behalf, we may make
payment directly to the state. Please contact Customer Service if you have questions (phone
numbers are printed on the back cover of this booklet).
To learn more about the CMS policy regarding Best Available Evidence please click the link
If you are not granted extra help, you can appeal a decision by completing this form: