This information is not a complete description of benefits. Contact the plan for more information. Limitations, copayments, and restrictions may apply. Benefits, premiums and/or copayments/coinsurance may change on January 1 of each year. You must continue to pay your Medicare part B premium. Our Medicare Special Needs Plan is for people with both Medicare and Medicaid. Your eligibility to enroll in this plan may depend on your Medicaid status. Premium, copays, coinsurance, and deductibles may vary based on the level of Extra Help you receive. Please contact the plan for further details. The formulary, pharmacy network, and/or provider network may change at any time. You will receive notice when necessary.