*The Alabama FlexCard Mastercard® Prepaid card is issued by Stride Bank, N.A., Member FDIC, pursuant to license by Mastercard International. *Only Ascensia (Contour) and LifeScan (One-Touch) products are preferred with a $0 copay for up to 204 diabetic test strips for 30 days and glucometers at the pharmacy and through mail-order home delivery. Once YOUR out-of-pocket spending on prescriptions reaches $8,000, you pay $0 for the rest of the calendar year. The $0 copay for Tier 6, Select Care Drugs, and the $35 copay for covered insulins will continue through the Coverage Gap Phase. Once the TOTAL prescription annual spending exceeds $5,030 and YOUR spending is below $8,000 you pay 25% of generic drug costs and 25% of brand-name drug costs. STANDARD Cost-Sharing Pharmacy Copays / Coinsurance PREFERRED Cost-Sharing Pharmacy Copays / Coinsurance Preventive & Comprehensive Dental Allowance $0 copay for annual routine exam & $25 copay for diagnostic exam $0 copay for annual routine exam & $30 copay for diagnostic exam *You must continue to pay your Medicare Part B premium if not otherwise paid for under Medicaid or by another third party. TTY users should call 1-80 or your State Medicaid Office. TTY users should call 1-87, 24 hours a day/7 days a week the Social Security Office at 1-80 between 7 a.m. To see if you qualify for getting Extra Help, call: 1-800-MEDICARE (1-80). You may be able to get Extra Help to pay for your prescription drug premiums and costs.

Extra help copays 2022