Benefits, formulary, pharmacy network, premium, and/or co-payments/coinsurance may change January 1, of each year.
Members may enroll in a Medicare plan only during specific times of the year, or around specific events or changes in individual circumstances as defined by Medicare. Contact Alight Retiree Health Solutions for more information.
You may be able to get extra help to pay for your prescription drug premiums and costs. If eligible, Medicare could pay for up to one hundred (100) percent of drug costs including monthly prescription drug premiums, annual deductibles, and co-insurance
Additionally, those who qualify will not be subject to the coverage gap or a late enrollment penalty. Many people are eligible for these savings and don't even know it. To see if you qualify for extra help, call: 1-800-MEDICARE (1-800-633-4227), TTY users should call 1-877-486-2048, 24 hours a day 7 days a week; or the Social Security Office at 1-800-772-1213 between 8 a.m and 8 p.m., Monday through Friday. TTY users should call 1-800-325-0778; or your State Medicaid Office.
You must live in the service area and have both Medicare Part A and Medicare Part B in order to enroll in a Medicare medical insurance plan (Medicare Advantage or Medigap plans).
This is not a complete listing of plans available in your service area. For a complete listing please contact 1-800-MEDICARE (1-800-633-4227) (TTY users should call 1-877-486-2048), 24 hours a day/7 days a week or consult www.medicare.gov.
For any plan that includes Part D benefits, eligible beneficiaries must use network pharmacies to access drug benefit, except in non-routine circumstances; and quality limits, restrictions may apply.
If you enroll in a plan with a closed provider network (a Medicare Advantage HMO), you must use plan providers except in emergency or urgent care situations or for out-of-area renal dialysis or other services. If you obtain routine care from out-of-network providers, neither Medicare nor the plan will be responsible for the costs.
Out-of-network/non-contracted providers are under no obligation to treat members, except in emergency situations. For a decision about whether a PPO plan will cover an out-of-network service, you or your provider are encouraged to ask for a pre-service organization determination before you receive the service. Please call the PPO plan's customer service number or see the Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services.
If you enroll in a plan that has a network, but allows you to see providers outside that network (Medicare Advantage PPOs, Cost, or Point of Sale plans), it may cost more to get care from out-of-network providers with the exception of emergencies or urgent care.
This information is available for free in other languages and alternate formats. For more information, contact the plan directly.