Monthly Premium, Deductible and Limits 
Monthly plan premium  $0 
You must keep paying your Medicare Part Bpremium. Your Part A 
and/or Part Bpremium may be paid on your behalf by the Kentucky 
Department of Medicaid Services (DMS) Program. 
Medical deductible  This plan does not have adeductible. 
Pharmacy (Part D) deductible  $0 if you qualify for "Extra Help"  
Maximum out-of-pocket 
responsibility  This plan does not have amaximum out-of-pocket responsibility. 
Covered Medical and Hospital Benefits