Plan Benefits or Information
Plan and Coverage Costs
Our Explanation of Coverage (EOC) is a document that gives full details about your coverage, what we must do, and your rights and responsibilities as a member of our plan. This document can be found online by visiting our Plan Materials and Forms page. If you have questions about plan benefits or services, please contact Member Services. We are here to help!
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 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.
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 for those that qualify for both Medicare and Medicaid. If you enroll in one of our HMO SNP plans, your Medicare and Medicaid coverage will be combined into a single plan.
Most of our plans include prescription drug coverage, extra benefits, and have low or $0 premiums.
There are two ways to see what drugs are covered with your plan.
- Contact Member Services to speak to a representative.
- Download the List of Drugs (Formulary) PDF. Go to the List of Drugs (Formulary) page and select the document for your plan. If you need help with doing a quick search for a drug, follow these simple steps.
- Once you open your plan document, press CTRL and F (at the same time) on your keyboard.
- A search box will on your screen.
- Type in the name of your drug in the search bar.
- Press enter. If covered, the drug will appear on your screen along with the tier level and prior authorization requirements.
There are several ways!
- You can enroll by phone, by mail/fax or enroll online.
- Visit our How to Enroll page for more details.
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.
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).
You are entitled to receive services from out-of-network providers for emergency or out-of-area urgently needed services. In addition, our plan must cover dialysis services for members with End-Stage Renal Disease (ESRD) who have traveled outside the plan’s service area and are not able to access network providers.