You qualify for LINET prescription drug coverage. You’re ready to use your benefits at the pharmacy. But how does it all work?

In this straightforward guide, we’ll help you get the most out of this temporary medication cost relief program. Keep reading to learn:

• How Medicare will notify you of your LINET coverage
• When your benefits begin and how long they will last
• Where you can use LINET
• What drugs LINET pays for
• How to submit a reimbursement claim if you need to
• Whom to contact for additional help

A quick LINET Program refresher

LINET helps low-income Medicare enrollees pay for their medications on a short-term basis.

To qualify, you must be eligible for the Medicare Part D Low Income Subsidy (“Extra Help”) and:¹

• Have both Medicare and Medicaid coverage (be dual-eligible); or
• Have both Medicare and Supplemental Security Income (SSI); or
• Have Medicare and qualify for a Medicare Savings Program (MSP); or
• Have applied for Extra Help through Social Security and received your Notice of Award

LINET applies only during the time you’re not enrolled in Part D drug coverage and may be retroactive. Generally, LINET benefits last between 1-2 months.¹

"If you have limited income and qualify for Extra Help bu thaven't enrolled in a Medicare Part D plan yet, LINET provides critical temporary coverage so you can access your prescriptions immediately—often with little to no copayment," explained Ryan Ramsey, NCOA Associate Director of Health Coverage and Benefits. "Even a short gap in prescription coverage can have serious health consequences when you're managing chronic conditions. LINET removes that financial barrier and gives you time to find the right Part D plan for your needs."

LINET At-a-Glance

Consult this chart for a brief overview and continue reading below for complete details.

When does my LINET coverage begin?

Coverage begins as soon as Medicare informs you that you’re eligible. This will happen in one of three ways:

• Medicare sends a letter on purple paper (CMS Product No. 11166)
  This is a Notice of Award for Extra Help. If you are dual-eligible, you receive SSI benefits, or you're enrolled in a Medicare Savings Program (MSP), Medicare automatically enrolls you in Extra Help and notifies you of your eligibility for Part D prescription drug coverage. You can use LINET during the time between choosing and enrolling in your Part D plan and when your benefits go into effect.
• Medicare sends a letter on yellow paper (CMS Product No. 11154)
  This is an Auto-Enrollment Notice for Part D. If you receive the purple letter above, and you do not choose a prescription drug plan, Medicare will choose one for you. You may use LINET until your Part D coverage kicks in. (You also may be eligible to request reimbursement for any prescriptions you paid for after you received purple letter no. 11166 and before your auto-enrollment in Part D takes effect).
• Medicare sends a (different) letter on yellow paper (CMS Product No. 11429)
  This is an Auto-Enrollment Retroactive Notice for Part D. If Medicare determines that your Medicaid or SSI benefits apply retroactively, then your eligibility for Extra Help also is retroactive. In this case, Medicare selects and enrolls you in a Part D plan and will notify you of this coverage. If you filled and paid for any prescriptions during this retroactive period, you can request reimbursement through LINET.

One other important thing to note: If Medicare did not auto-enroll you in Extra Help—and you applied for the program on your own—you could be eligible for LINET benefits while you await a decision. This is called “immediate need.” Immediate need only applies if you can show reasonable proof (Medicare calls this “best available evidence”, or BAE) that you most likely will qualify for Extra Help.² This proof can include one of the following:

• A letter from Medicare showing your Extra Help application status
• A copy of your Medicaid award letter with effective dates
• A verification process that the pharmacist can run on the computer

You must claim immediate need at the pharmacy counter. It’s important that you have the right documentation with you when you do; otherwise, you will be responsible for paying for your prescription out of pocket.

How do I use my LINET benefits?

Medicare contracts exclusively with Humana to administer the program. There are two ways to take advantage of this assistance:

1. Visit the pharmacy
   Simply bring your prescription(s) to any pharmacy—there are no restrictions on where you can fill them.³ Present your Medicare I.D. number to the pharmacist, who will submit a claim to Humana LINET on your behalf. LINET will reimburse the pharmacy directly; you will not have to pay anything at the counter.
2. Submit a claim
   If you paid out-of-pocket for a prescription while you were eligible for LINET, you may request reimbursement from Humana.¹ (See “How can I get reimbursed for a prescription?” below for more information).

How do I know if LINET covers my medications?

LINET has an open formulary. That means it includes all Medicare Part D drugs, except those that are restricted or excluded from coverage by federal law.¹

The following medications are currently excluded under Part D:

• Drugs used to treat weight loss, weight gain, or anorexia (exception: drugs used to treat physical wasting caused by cancer and other diseases)
• Fertility drugs
• Drugs used to treat erectile dysfunction
• Drugs designed to relieve cold or cough symptoms
• Drugs used for hair growth or other cosmetic purposes (exception: drugs used to treat conditions like acne, psoriasis, vitiligo)
• Prescription vitamins and minerals (exception: prenatal vitamins, fluoride treatments)
• Non-prescription drugs (over-the-counter medications like Tylenol)

Some other restrictions apply as well, mostly having to do with safety concerns. For example, LINET may only cover a certain number of pills even if your health care provider wrote a prescription for more. A pharmacist can help you figure this out.

For a current list of covered and excluded drugs, as well as those that require prior authorization, you may check Humana’s online list.

What happens if I try to fill a LINET prescription, but the pharmacy doesn’t know what to do?

This is a common situation, so don’t panic. Ask your pharmacist to process your claim using the following two numbers:²

• BIN: 015599
• PCN: 005440000

Consider writing these numbers down and keeping them with your Medicare I.D. card so you’re ready if and when this situation occurs. Or you can print off the Humana Pharmacy assistance page.

If you don’t have these numbers handy, ask the pharmacist to call Humana’s LINET Help Desk at 800-783-1307 (TTY: 711). Worst-case, you can pay for your prescription yourself, keep the printed receipt, and then submit it for reimbursement (see how to do this below).

How can I get reimbursed for a prescription?

If you had to pay for any prescription drugs yourself during your LINET coverage period, you may ask for reimbursement.

To submit a LINET claim, take the following steps:

1. Access the Prescription Drug Claim Form for Member Reimbursement (English) or the Prescription Drug Claim Form for Member Reimbursement (Spanish). You can print it out and write your answers by hand or type your answers directly into the boxes.

2. Gather any required documentation. It may be helpful to review the entire form first, before you begin, so that you know what information you’ll need.

3. Complete all requested sections. You will find detailed instructions for each part of the form, including where to find additional help.

4. Review your form. Check your answers and make sure you completed every box. If you filled out the form electronically, save your answers and print it out.

5. Submit your claim:

Fax it to:
1-877-210-5592

Mail it to:
Limited Income NET Program
P.O. Box 14310
Lexington, KY 40512-4140

Note that you must request reimbursement within 36 months. And remember: always keep your pharmacy receipts and proof of payment! Humana will deny your claim unless you can show that you paid out of pocket.

What if I have more questions about LINET?

Consult Humana’s comprehensive resource page for LINET beneficiaries. Or, contact Humana’s LINET customer service department at 1-800-783-1307 (TTY: 711). Representatives are available Monday – Friday, 8 a.m. to 7 p.m. Eastern time.

Sources

1.    Humana. LINET – Beneficiary Resources. Found on the internet at https://www.humana.com/member/medicare-linet-beneficiary-resources

2.    Humana. LINET – Pharmacy Resources. Found on the internet at https://provider.humana.com/pharmacy-resources/medicare-linet

3.    Centers for Medicare & Medicaid Services. Medicare’s Limited Income NET (LINET) Program for People at the Pharmacy Counter. Found on the internet at https://www.cms.gov/files/document/11328-p-limited-income-net-people-pharmacy-counter.pdf

4.    Humana. Pharmacy News Bulletin: Limited Income NET (LINET) Program. Found on the internet at https://docushare-web.apps.external.pioneer.humana.com/Marketing/docushare-app?file=2625285