MEDICARE MEMBERS: PROTECT YOURSELF AGAINST MEDICARE FRAUD AND IDENTIFY THEFT! THE U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES OFFICE OF INSPECTOR GENERAL IS ALERTING THE PUBLIC ABOUT A FRAUD SCHEME INVOLVING GENETIC TESTING. LEARN HOW TO PROTECT YOURSELF.
Frequently Asked Questions
- Part A - Hospital coverage
- Part B - Medical coverage
- Part C - Also known as “Medicare Advantage.” Combines hospital (Part A) and medical (Part B) coverage in one plan. In addition, you may have access to:
- Low or $0 monthly premiums
- Prescription drug coverage (Part D)
- Extra benefits that are not available through Original Medicare such as vision benefits, dental benefits, hearing benefits, or fitness or gym membership
- Part D - Prescription drug coverage that is only available when you enroll in a Medicare Advantage plan that includes prescription drug coverage (MAPD) or purchase a separate Prescription Drug Plan (PDP).
Medicare Supplement plans are an alternative to Original Medicare or Medicare Advantage plans.
Medicare Supplement plans:
- are designed to fill gaps left by Original Medicare.
- generally cost more per month and offer more comprehensive coverage than Medicare Advantage plans.
- do not include prescription drug coverage. If you want that important option, you must purchase it separately.
- allow you to see any provider who accepts Medicare.
- may not be combined with a Medicare Advantage plan.
Most people are automatically enrolled in Medicare Part A when they turn 65. You can enroll in Medicare Part B as early as the first day of the month, three months before your birth month.
As soon as you enroll in Part B, you can choose what type of additional coverage you want—a Medicare Advantage plan or a Medicare Supplement Plan.
Don’t forget to also enroll in a prescription drug plan (Part D) if it’s not already included with your plan. This way, you can protect yourself from the high cost of prescription drugs.
Keep in mind that if you do not enroll in Medicare Part B AND choose prescription drug coverage during this Initial Enrollment Period, you may be subject to a penalty if you enroll later.
You can choose a new plan each year. All Medicare beneficiaries have an opportunity to choose or change plans each year during the Medicare Annual Enrollment Period, which begins on October 15 and ends on December 7.
The choices you make during the Annual Enrollment Period will take effect on January 1 of the upcoming year.
Between January 1 and March 31 of each year, you will have a single opportunity to switch your Medicare Advantage plan or return to original Medicare. Please note this opportunity is available only one time during this period.
Yes. A Medicare Special Enrollment Period allows you to enroll in Medicare or change your plan at other times of the year. Such circumstances include:
- When you first become eligible for Medicare.
- If you are on both Medicare and Medicaid.
- If your current plan is terminated.
- If you move to a community not served by your current plan.
- Other circumstances as defined by the Centers for Medicare and Medicaid Service.
Yes. If you have limited income and resources, Medicare will provide "Extra Help" to pay for your plan's monthly premium, yearly deductible, prescription co-payments and coinsurance. Resources include your savings and stocks, but not your home or car. This Extra Help also counts toward your out-of-pocket costs.
Some people automatically qualify for Extra Help and don't need to apply. Medicare will mail a letter to people who automatically qualify for Extra Help.
To see if you qualify for getting Extra Help call:
- 1-800-MEDICARE (1-800-633-4227). TTY users call 1-877-486-2048. Get information 24 hours a day, 7 days a week. You can also visit www.medicare.gov (By clicking on this link you will be leaving this website.) to view a copy of the 'Medicare and You' handbook - see section 'Programs for People with Limited Income and Resources'; or
- The Social Security Administration at 1-800-772-1213 between 7:00 a.m. and 7:00 p.m., Monday through Friday. TTY users call 1-800-325-0778; or
- Your State Medicaid Office
After you apply, you will get a letter letting you know if you qualify for Extra Help and what you need to do next.
Premiums, copays, coinsurance and deductibles may vary based on the level of Extra Help you receive. Please contact the plan for further details.
Once you enroll in Medicare, you’ll have three basic choices for receiving your health coverage:
- Original Medicare (Part A and Part B)
- Medicare Advantage (Part C)
- Medicare Supplement
Original Medicare DOES NOT cover all of your medical expenses.
It’s important for you to know that Original Medicare covers only about 80% of your eligible expenses. You are responsible for the rest. Also remember that Original Medicare does not include prescription drug coverage.
No, prescription drug coverage is NOT INCLUDED with Original Medicare or Medicare Supplement Plans.
Medicare Part D prescription drug coverage is an important option that is available either as a standalone plan or as part of a Medicare Advantage Plan.
Just remember, if you do not sign up for prescription drug coverage during your Initial Election Period you may encounter a penalty if you sign up at a later date.
You can select Medicare Part D prescription drug coverage as a standalone plan or as part of Medicare Advantage Plan.
Prescription coverage is NOT INCLUDED with Original Medicare or Medicare Supplement Plans.
Plan Enrollment and Coverage
You can enroll in our HMO plans if you are eligible for Medicare Part A and Part B.
HMO SNP plans are special needs plans designated for people with special health care needs. Our plan is designed for people that qualify for both Medicare and Medicaid.
Most of our plans include prescription drug coverage, extra benefits, and have low or $0 premiums.
A drug list – also called a formulary – lists your health plan’s preferred medicines. You usually pay less when you choose a drug that’s on the list.
You can authorize anyone (like a relative, friend, advocate, an attorney, or a doctor) to act as your representative and file an appeal or ask for a coverage decision on your behalf. Just complete an Appointment of Representative form (By clicking on this link you will be leaving this website.) and follow the instructions on where to send it.
Visit your state's Appeals and Grievances web page for more information about this form and how to authorize a representative.
Your Medicare plan will renew automatically each year unless you make changes to your coverage. You may choose to change your coverage during the Annual Enrollment Period: October 15 – December 7.
If you are a member of a Dual Eligible Special Needs Plan (DSNP), your renewal is contingent upon your Medicaid eligibility.
If you qualify for a Special Enrollment Period, you can change plans according to the situation that is allowing you a Special Enrollment Period.
Thank you for joining. We are looking forward to starting a new journey with you. Your plan coverage will start on January 1. As a new member you will receive materials from us, such as:
- A new Membership ID Card.
- A Welcome Kit.
- A Welcome telephone call from our Member Services team.
Creating an account is easy! Just follow the below steps:
- Go to the Member Login
- Search for your member information by entering your Medicare Advantage ID number. This number can be found on your ID card.
- Register your account by entering your email address and choose a password. A confirmation message will appear on the screen. You will also receive an email to verify your account and to complete your account registration.
- Once you've verified your account, you can then choose your preferred language and add answers to the secret questions you pick. These questions will help you access your account if you forget your password. When you are done, click "Next" to finish your account registration.
Once your account has been created, you can use your member account to:
- View your plan benefits and claims information.
- Get a replacement ID card.
- Search or select a primary care provider (PCP).
- Send or receive secure messages about your plan coverage.
If you have questions setting up or logging into your account, please contact Member Services. We are here to help!
For certain kinds of drugs, you can use our mail-order services. Generally, the drugs provided through mail-order (MO) are drugs that you take on a regular basis for a chronic or long-term medical condition such as high blood pressure or diabetes. The drugs available through our plan’s mail-order service are marked as “mail-order or MO” in your state's List of Drugs (Formulary) page.
Our plan’s mail-order service allows you to order up to a 90-day supply. To get order forms and information about filling your prescriptions by mail, contact Member Services.
You can ask questions and get support from our Member Services team 7 days a week. From October 1 – March 31 you can call us 7 days a week from 8 a.m. to 8 p.m. From April 1 – September 30, you can call us Monday – Friday from 8 a.m. to 8 p.m. A messaging system is used after hours, weekends, and on federal holidays. Here are some ways you can contact us.
Create or log into your online member account to send secure messages.
How to Get Care
Network providers are doctors, pharmacies, hospitals, and other health care professionals or facilities that have an agreement with us to deliver covered services to members in our plan. You can use our Find a Provider tool to see if your doctor, pharmacy, or other healthcare professional or facility is in our network.
Your doctor or pharmacy should be an in-network provider, so your health services are covered. If you use an out-of-network provider, you will likely pay more for your healthcare services.
If you need care and an in-network provider is unable to provide this care, you may be able to get care from an out-of-network provider. Your PCP must confirm there is not a network provider available and contact the plan to request authorization for you to obtain services from an out-of-network provider. If approved, the out-of-network provider will be issued an authorization to provide the service(s).
Please note out-of-network/non- contracted providers are under no obligation to treat our members, except in emergency situations. Please call our customer service number or see your Evidence of Coverage for more information, including the cost- sharing that applies to out-of-network services
Your PCP is your main doctor. Your PCP should know your complete medical history to evaluate changes in your health. You can visit your PCP for sick and well visits. Your PCP will also help with coordinating other services, such as seeing a specialist or having a procedure in a hospital or an outpatient facility.
If you don't have a PCP, here are ways to choose one:
- Use our Find a Provider tool to find an in-network provider and contact Member Services with your selection.
- Or, you can just call us! Member Services will help you find a PCP.
If you already have a PCP:
That’s great! You may want to contact Member Services or use our Find a Provider tool to make sure your PCP is in our network. If your PCP is not in our network, don’t worry, we will work with you to make sure you are assigned a PCP that is in our network.
Deciding where to go for care can sometimes be confusing. For non-emergency illness or injury, call your PCP, contact the 24/7 nurse advice line or visit an in-network urgent care facility. If you feel you are experiencing a life-threatening condition, go to the emergency room (ER).
See below to help you decide where to go for the care you need.
DO YOU HAVE A PHYSICAL INJURY OR ILLNESS LIKE THE FLU? IF YES...
- Reach out to your state's Nurse Hotline that is open 24/7.
Get quick, reliable answers to your health questions.
- Call Your Primary Care Provider (PCP)
Set up an appointment to see your main doctor.
- Go to In-Network Urgent Care
Get quickly diagnosed and treated for less serious illnesses or injuries.
CALL 9-1-1 IMMEDIATELY OR GO TO AN EMERGENCY ROOM IF:
You feel you have a life-threatening injury or illness like:
- Chest pains
- Bleeding that won’t stop
- Shortness of breath
- Broken bones
- Severe cuts or burns
Always follow up with your PCP if you have gone to an emergency room, visited an urgent care facility or had a hospital stay.