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2013 Medicare Advantage Plan Benefit Details for the Care Improvement Plus Medicare Advantage (PPO)
This is archive material for research purposes. Please see PDPFinder.com or MAFinder.com for current plans.

2013 Medicare Advantage Plan Details
Medicare Plan Name:Care Improvement Plus Medicare Advantage (PPO)
Location:Marquette, Wisconsin     Click to see other locations
Plan ID:H0294 - 004 - 0     Click to see other plans
Member Services:1-800-204-1002 TTY users 711
— This plan information is for research purposes only. —
Click here to see plans for the current plan year
Medicare Contact Information:Please go to Medicare.gov or call 1-800-MEDICARE (1-800-633-4227) to get information on all of your options.
TTY users 1-877-486-2048
or contact your local SHIP for assistance
Email a copy of the Care Improvement Plus Medicare Advantage (PPO) benefit details
— Medicare Plan Features —
Monthly Premium:$0.00 (see Plan Premium Details below)
Annual Deductible:$0
Annual Initial Coverage Limit (ICL):$2,970
Health Plan Type:Local PPO
Maximum Out-of-Pocket Limit for Parts A & B (MOOP):$6,700
Additional Gap Coverage?No additional gap coverage, only the Donut Hole Discount
Total Number of Formulary Drugs:3,401 drugsBrowse the Care Improvement Plus Medicare Advantage (PPO) Formulary
This plan has 4 drug tiers. See cost-sharing highlights below.
Formulary Drug Details:Tier 1Tier 2Tier 3Tier 4Tier 5
• Preferred Pharmacy
  Cost-Sharing during
  initial coverage phase:		$8.00$45.00$95.0033% 
• Number of Drugs per
  Tier:		2069860196323
Plan's Pharmacy Search:http://www.careimprovementplus.com
Plan Offers Mail Order?Yes
Number of Members enrolled in this plan in (H0294 - 004):2,494 members
Plan’s Summary Star Rating: New plan - No summary rating as of yet.
• Customer Service Rating: Insufficient data to rate this plan.
• Member Experience Rating: Insufficient data to rate this plan.
• Drug Cost Accuracy Rating: Insufficient data to rate this plan.
— Plan Premium Details —
Monthly Premium with Extra Help Low-Income Subsidy (LIS): ❔100%
Subsidy		75%
Subsidy		50%
Subsidy		25%
Subsidy
Monthly Part D Premium with LIS:$0.00$0.00$0.00$0.00
— Plan Health Benefits —
** Cost **
Premium and Other Important Information
$0 monthly plan premium in addition to your monthly Medicare Part B premium.
Most people will pay the standard monthly Part B premium in addition to their MA plan premium. However some people will pay higher Part B and Part D premiums because of their yearly income (over $85 000 for singles $170 000 for married couples). For more information about Part B and Part D premiums based on income call Medicare at 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048. You may also call Social Security at 1-800-772-1213. TTY users should call 1-800-325-0778.
Some physicians providers and suppliers that are out of a plan’s network (i.e. out-of-network) accept "assignment" from Medicare and will only charge up to a Medicare-approved amount. If you choose to see an out-of-network physician who does NOT accept Medicare "assignment " your coinsurance can be based on the Medicare-approved amount plus an additional amount up to a higher Medicare "limiting charge." If you are a member of a plan that charges a copay for out-of-network physician services the higher Medicare "limiting charge" does not apply. See the publications Medicare You or Your Medicare Benefits available on www.medicare.gov for a full listing of benefits under Original Medicare as well as for explanations of the rules related to "assignment" and "limiting charges" that apply by benefit type. To find out if physicians and DME suppliers accept assignment or participate in Medicare visit www.medicare.go
$6 700 out-of-pocket limit for Medicare-covered services.
$6 700 out-of-pocket limit for Medicare-covered services.
** Doctor and Hospital Choice **
Doctor and Hospital Choice
No referral required for network doctors specialists and hospitals.
You can go to doctors specialists and hospitals in or out of the network. It will cost more to get out of network benefits.
** Extra Benefits **
Over-the-Counter Items
The plan does not cover Over-the-Counter items.
Transportation
Authorization rules may apply.
$0 copay for up to 6 one-way trip(s) to plan approved location every year
$0 copay for transportation.
** Important Information **
Premium and Other Important Information
$0 monthly plan premium in addition to your monthly Medicare Part B premium.
Most people will pay the standard monthly Part B premium in addition to their MA plan premium. However some people will pay higher Part B and Part D premiums because of their yearly income (over $85 000 for singles $170 000 for married couples). For more information about Part B and Part D premiums based on income call Medicare at 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048. You may also call Social Security at 1-800-772-1213. TTY users should call 1-800-325-0778.
Some physicians providers and suppliers that are out of a plan’s network (i.e. out-of-network) accept "assignment" from Medicare and will only charge up to a Medicare-approved amount. If you choose to see an out-of-network physician who does NOT accept Medicare "assignment " your coinsurance can be based on the Medicare-approved amount plus an additional amount up to a higher Medicare "limiting charge." If you are a member of a plan that charges a copay for out-of-network physician services the higher Medicare "limiting charge" does not apply. See the publications Medicare You or Your Medicare Benefits available on www.medicare.gov for a full listing of benefits under Original Medicare as well as for explanations of the rules related to "assignment" and "limiting charges" that apply by benefit type. To find out if physicians and DME suppliers accept assignment or participate in Medicare visit www.medicare.go
$6 700 out-of-pocket limit for Medicare-covered services.
$6 700 out-of-pocket limit for Medicare-covered services.
Doctor and Hospital Choice
No referral required for network doctors specialists and hospitals.
You can go to doctors specialists and hospitals in or out of the network. It will cost more to get out of network benefits.
** Inpatient Care **
Inpatient Hospital Care
Plan covers 90 days each benefit period.
For Medicare-covered hospital stays:
  • Days 1 - 5: $295 copay per day
  • Days 6 - 90: $0 copay per day
    • Plan covers 60 lifetime reserve days. $0 copay per lifetime reserve day.
    Except in an emergency your doctor must tell the plan that you are going to be admitted to the hospital.
    For hospital stays:
    • Days 1 - 5: $295 copay per day
  • Days 6 - 90: $0 copay per day
    • Inpatient Mental Health Care
    You get up to 190 days of inpatient psychiatric hospital care in a lifetime. Inpatient psychiatric hospital services count toward the 190-day lifetime limitation only if certain conditions are met. This limitation does not apply to inpatient psychiatric services furnished in a general hospital.
    $1 100 copay for each Medicare-covered hospital stay.
    Except in an emergency your doctor must tell the plan that you are going to be admitted to the hospital.
    $1 100 copay for each hospital stay.
    Skilled Nursing Facility (SNF)
    Authorization rules may apply.
    Plan covers up to 100 days each benefit period
    No prior hospital stay is required.
    For Medicare-covered SNF stays:
    • Days 1 - 20: $0 copay per day
  • Days 21 - 100: $130 copay per day
    • For each SNF stay:
    • Days 1 - 20: $0 copay per SNF day
  • Days 21 - 100: $130 copay per SNF day
    • Home Health Care
    Authorization rules may apply.
    $0 copay for each Medicare-covered home health visit
    40% of the cost for Medicare-covered home health visits
    Hospice
    You must get care from a Medicare-certified hospice. Your plan will pay for a consultative visit before you select hospice.
    ** Outpatient Care **
    Doctor Office Visits
    $25 copay for each Medicare-covered primary care doctor visit.
    $40 copay for each Medicare-covered specialist visit.
    $25 copay for each Medicare-covered primary care doctor visit
    $40 copay for each Medicare-covered specialist visit
    Chiropractic Services
    $20 copay for each Medicare-covered chiropractic visit
    Medicare-covered chiropractic visits are for manual manipulation of the spine to correct subluxation (a displacement or misalignment of a joint or body part) if you get it from a chiropractor.
    $20 copay for Medicare-covered chiropractic visits.
    Podiatry Services
    $40 copay for each Medicare-covered podiatry visit
    Medicare-covered podiatry visits are for medically-necessary foot care.
    $40 copay for Medicare-covered podiatry visits
    Outpatient Mental Health Care
    Authorization rules may apply.
    $40 copay for each Medicare-covered individual therapy visit
    $25 copay for each Medicare-covered group therapy visit
    $40 copay for each Medicare-covered individual therapy visit with a psychiatrist
    $25 copay for each Medicare-covered group therapy visit with a psychiatrist
    $40 copay for Medicare-covered partial hospitalization program services
    $25 to $40 copay for Medicare-covered Mental Health visits with a psychiatrist
    $25 to $40 copay for Medicare-covered Mental Health visits
    $40 copay for Medicare-covered partial hospitalization program services
    Outpatient Substance Abuse Care
    $40 copay for Medicare-covered individual substance abuse outpatient treatment visits
    $25 copay for Medicare-covered group substance abuse outpatient treatment visits
    $25 to $40 copay Medicare-covered substance abuse outpatient treatment visits
    Outpatient Services
    Authorization rules may apply.
    $250 copay for each Medicare-covered ambulatory surgical center visit
    $250 copay for each Medicare-covered outpatient hospital facility visit
    $250 copay for Medicare-covered outpatient hospital facility visits
    $250 copay for Medicare-covered ambulatory surgical center visits
    Ambulance Services
    $185 copay for Medicare-covered ambulance benefits.
    $185 copay for Medicare-covered ambulance benefits.
    Emergency Care
    $65 copay for Medicare-covered emergency room visits
    Worldwide coverage.
    If you are admitted to the hospital within 24-hour(s) for the same condition you pay $0 for the emergency room visit.
    Urgently Needed Care
    $25 to $30 copay for Medicare-covered urgently-needed-care visits
    Outpatient Rehabilitation Services
    Authorization rules may apply.
    There may be limits on physical therapy occupational therapy and speech and language pathology visits. If so there may be exceptions to these limits.
    $40 copay for Medicare-covered Occupational Therapy visits
    $40 copay for Medicare-covered Physical Therapy and/or Speech and Language Pathology visits
    $40 copay for Medicare-covered Physical Therapy and/or Speech and Language Pathology visits
    $40 copay for Medicare-covered Occupational Therapy visits.
    ** Outpatient Medical Services and Supplies **
    Durable Medical Equipment
    Authorization rules may apply.
    20% of the cost for Medicare-covered durable medical equipment
    You may pay less if you purchase these items from the plan’s preferred manufacturers/vendors. Contact the plan for a list of non-preferred and preferred manufacturers/vendors.
    35% of the cost for Medicare-covered durable medical equipment
    Prosthetic Devices
    Authorization rules may apply.
    20% of the cost for Medicare-covered prosthetic devices
    20% of the cost for Medicare-covered prosthetic devices.
    Diabetes Programs and Supplies
    $0 copay for Medicare-covered Diabetes self-management training
    $0 copay for Medicare-covered Diabetes monitoring supplies
    $0 copay for Medicare-covered Therapeutic shoes or inserts
    $0 copay for Medicare-covered Diabetes self-management training
    $0 copay for Medicare-covered Diabetes monitoring supplies
    $0 copay for Medicare-covered Therapeutic shoes or inserts
    Diagnostic Tests, X-Rays, Lab Services, and Radiology Services
    Authorization rules may apply.
    $15 copay for Medicare-covered lab services
    $15 copay for Medicare-covered diagnostic procedures and tests
    $15 copay for Medicare-covered X-rays
    20% of the cost for Medicare-covered diagnostic radiology services (not including X-rays)
    20% of the cost for Medicare-covered therapeutic radiology services
    If the doctor provides you services in addition to Outpatient Diagnostic Procedures Tests and Lab Services separate cost sharing of $25 to $40 may apply
    If the doctor provides you services in addition to Outpatient Diagnostic and Therapeutic Radiology Services separate cost sharing of $25 to $40 may apply
    20% of the cost for Medicare-covered therapeutic radiology services
    $15 copay for Medicare-covered outpatient X-rays
    20% of the cost for Medicare-covered diagnostic radiology services
    $15 copay for Medicare-covered diagnostic procedures tests and lab services
    ** Preventive Services **
    Cardiac and Pulmonary Rehabilitation Services
    Authorization rules may apply.
    $40 copay for Medicare-covered Cardiac Rehabilitation Services
    $40 copay for Medicare-covered Intensive Cardiac Rehabilitation Services
    $40 copay for Medicare-covered Pulmonary Rehabilitation Services
    $40 copay for Medicare-covered Cardiac Rehabilitation Services
    $40 copay for Medicare-covered Intensive Cardiac Rehabilitation Services
    $40 copay for Medicare-covered Pulmonary Rehabilitation Services
    Preventive Services and Wellness/Education Programs
    $0 copay for all preventive services covered under Original Medicare at zero cost sharing. Any additional preventive services approved by Medicare mid-year will be covered by the plan or by Original Medicare.
    The plan covers the following supplemental education/wellness programs:
    • Health Education
  • Additional Smoking and Tobacco Use Cessation Visits
  • Nursing Hotline
    • $0 copay for Medicare-covered preventive services
    $0 copay for supplemental education/wellness programs
    Kidney Disease and Conditions
    20% of the cost for Medicare-covered renal dialysis
    $0 copay for Medicare-covered kidney disease education services
    $0 copay for Medicare-covered kidney disease education services
    20% of the cost for Medicare-covered renal dialysis
    Outpatient Prescription Drugs
    20% of the cost for Medicare Part B drugs out-of-network.
    20% of the cost for Medicare Part B chemotherapy drugs and other Part B drugs.
    This plan uses a formulary. The plan will send you the formulary. You can also see the formulary at www.careimprovementplus.com on the web.
    Different out-of-pocket costs may apply for people who
    • have limited incomes
    • live in long term care facilities or
    • have access to Indian/Tribal/Urban (Indian Health Service) providers.
    The plan offers national in-network prescription coverage (i.e. this would include 50 states and the District of Columbia). This means that you will pay the same cost-sharing amount for your prescription drugs if you get them at an in-network pharmacy outside of the plan’s service area (for instance when you travel).
    Total yearly drug costs are the total drug costs paid by both you and a Part D plan.
    The plan may require you to first try one drug to treat your condition before it will cover another drug for that condition.
    Some drugs have quantity limits.
    Your provider must get prior authorization from Care Improvement Plus Medicare Advantage (PPO) for certain drugs.
    You must go to certain pharmacies for a very limited number of drugs due to special handling provider coordination or patient education requirements that cannot be met by most pharmacies in your network. These drugs are listed on the plan’s website formulary printed materials as well as on the Medicare Prescription Drug Plan Finder on Medicare.gov.
    If the actual cost of a drug is less than the normal cost-sharing amount for that drug you will pay the actual cost not the higher cost-sharing amount.
    If you request a formulary exception for a drug and Care Improvement Plus Medicare Advantage (PPO) approves the exception you will pay Tier 3: Non-Preferred Brand cost sharing for that drug.
    $0 deductible.
    You pay the following until total yearly drug costs reach $2 970:
    Tier 1: Generic
    Tier 2: Preferred Brand
    Tier 3: Non-Preferred Brand
    Tier 4: Specialty Tier
    • $8 copay for a one-month (30-day) supply of drugs in this tier
  • $45 copay for a one-month (30-day) supply of drugs in this tier
  • $95 copay for a one-month (30-day) supply of drugs in this tier
  • 33% coinsurance for a one-month (30-day) supply of drugs in this tier
  • $16 copay for a two-month (60-day) supply of drugs in this tier
  • $90 copay for a two-month (60-day) supply of drugs in this tier
  • $190 copay for a two-month (60-day) supply of drugs in this tier
  • 33% coinsurance for a two-month (60-day) supply of drugs in this tier
  • $24 copay for a three-month (90-day) supply of drugs in this tier
  • $135 copay for a three-month (90-day) supply of drugs in this tier
  • $285 copay for a three-month (90-day) supply of drugs in this tier
  • 33% coinsurance for a three-month (90-day) supply of drugs in this tier
    • Tier 1: Generic
    Tier 2: Preferred Brand
    Tier 3: Non-Preferred Brand
    Tier 4: Specialty Tier
    • $8 copay for a one-month (31-day) supply of drugs in this tier
  • 33% coinsurance for a one-month (31-day) supply of drugs in this tier
  • $45 copay for a one-month (31-day) supply of drugs in this tier
  • $95 copay for a one-month (31-day) supply of drugs in this tier
    • Please note that brand drugs must be dispensed incrementally in long-term care facilities. Generic drugs may be dispensed incrementally. Contact your plan about cost-sharing billing/collection when less than a one-month supply is dispensed.
    Tier 1: Generic
    Tier 2: Preferred Brand
    Tier 3: Non-Preferred Brand
    Tier 4: Specialty Tier
    • $8 copay for a one-month (30-day) supply of drugs in this tier
  • $45 copay for a one-month (30-day) supply of drugs in this tier
  • $95 copay for a one-month (30-day) supply of drugs in this tier
  • 33% coinsurance for a one-month (30-day) supply of drugs in this tier
  • $16 copay for a two-month (60-day) supply of drugs in this tier
  • $90 copay for a two-month (60-day) supply of drugs in this tier
  • $190 copay for a two-month (60-day) supply of drugs in this tier
  • 33% coinsurance for a two-month (60-day) supply of drugs in this tier
  • $20 copay for a three-month (90-day) supply of drugs in this tier
  • $112.50 copay for a three-month (90-day) supply of drugs in this tier
  • $237.50 copay for a three-month (90-day) supply of drugs in this tier
  • 33% coinsurance for a three-month (90-day) supply of drugs in this tier
    • After your total yearly drug costs reach $2 970 you receive limited coverage by the plan on certain drugs. You will also receive a discount on brand name drugs and generally pay no more than 47.5% for the plan’s costs for brand drugs and 79% of the plan’s costs for generic drugs until your yearly out-of-pocket drug costs reach $4 750.
    After your yearly out-of-pocket drug costs reach $4 750 you pay the greater of:
    • 5% coinsurance or
    • $2.65 copay for generic (including brand drugs treated as generic) and a $6.60 copay for all other drugs.
    Plan drugs may be covered in special circumstances for instance illness while traveling outside of the plan’s service area where there is no network pharmacy. You may have to pay more than your normal cost-sharing amount if you get your drugs at an out-of-network pharmacy. In addition you will likely have to pay the pharmacy’s full charge for the drug and submit documentation to receive reimbursement from Care Improvement Plus Medicare Advantage (PPO).
    You will be reimbursed up to the plan’s cost of the drug minus the following for drugs purchased out-of-network until total yearly drug costs reach $2 970:
    Tier 1: Generic
    Tier 2: Preferred Brand
    Tier 3: Non-Preferred Brand
    Tier 4: Specialty Tier
    • $8 copay for a one-month (30-day) supply of drugs in this tier
  • $45 copay for a one-month (30-day) supply of drugs in this tier
  • $95 copay for a one-month (30-day) supply of drugs in this tier
  • 33% coinsurance for a one-month (30-day) supply of drugs in this tier
    • You will be reimbursed up to 21% of the plan allowable cost for generic drugs purchased out-of-network until total yearly out-of-pocket drug costs reach $4 750. Please note that the plan allowable cost may be less than the out-of-network pharmacy price paid for your drug(s). You will be reimbursed up to 52.5% of the plan allowable cost for brand name drugs purchased out-of-network until your total yearly out-of-pocket drug costs reach $4 750. Please note that the plan allowable cost may be less than the out-of-network pharmacy price paid for your drug(s).
    After your yearly out-of-pocket drug costs reach $4 750 you will be reimbursed for drugs purchased out-of-network up to the plan’s cost of the drug minus your cost share which is the greater of:
    • 5% coinsurance or
    • $2.65 copay for generic (including brand drugs treated as generic) and a $6.60 copay for all other drugs.
    Dental Services
    Authorization rules may apply.
    $0 copay for Medicare-covered dental benefits
    $10 copay for a visit that includes:
    • up to 1 oral exam(s) every year
  • up to 1 cleaning(s) every year
  • up to 1 dental x-ray(s) every year
    • $0 copay for Medicare-covered comprehensive dental benefits
    $10 copay for supplemental preventive dental benefits
    Hearing Services
    $0 copay for:
    $40 copay for Medicare-covered diagnostic hearing exams
    $390 copay for up to 2 inner-ear hearing aid(s) every year
    $340 copay for up to 2 over-the-ear hearing aid(s) every year
    $40 copay for Medicare-covered diagnostic hearing exams.
    $340 to $390 copay for supplemental hearing aids.
    ** Additional Benefits **
    Vision Services
    • $40 copay for one pair of Medicare-covered eyeglasses or contact lenses after cataract surgery.
  • $0 to $40 copay for Medicare-covered exams to diagnose and treat diseases and conditions of the eye.
  • $10 copay for up to 1 supplemental routine eye exam(s) every year
  • $0 copay for glasses
  • $0 copay for contacts
    • $0 to $40 copay for Medicare-covered eye exams
    $10 copay for supplemental eye exams
    $40 copay for Medicare-covered eye wear
    $0 copay for supplemental eye wear
    $150 plan coverage limit for eye wear every year. This limit applies to both in-network and out-of-network benefits.
    Over-the-Counter Items
    The plan does not cover Over-the-Counter items.
    Transportation
    Authorization rules may apply.
    $0 copay for up to 6 one-way trip(s) to plan approved location every year
    $0 copay for transportation.
    Acupuncture
    This plan does not cover Acupuncture.
    ** Inpatient Care **
    Inpatient Hospital Care
    Plan covers 90 days each benefit period.
    For Medicare-covered hospital stays:
    • Days 1 - 5: $295 copay per day
  • Days 6 - 90: $0 copay per day
    • Plan covers 60 lifetime reserve days. $0 copay per lifetime reserve day.
    Except in an emergency your doctor must tell the plan that you are going to be admitted to the hospital.
    For hospital stays:
    • Days 1 - 5: $295 copay per day
  • Days 6 - 90: $0 copay per day
    • ** Outpatient Care **
    Doctor Office Visits
    $25 copay for each Medicare-covered primary care doctor visit.
    $40 copay for each Medicare-covered specialist visit.
    $25 copay for each Medicare-covered primary care doctor visit
    $40 copay for each Medicare-covered specialist visit
    Outpatient Services
    Authorization rules may apply.
    $250 copay for each Medicare-covered ambulatory surgical center visit
    $250 copay for each Medicare-covered outpatient hospital facility visit
    $250 copay for Medicare-covered outpatient hospital facility visits
    $250 copay for Medicare-covered ambulatory surgical center visits
    Ambulance Services
    $185 copay for Medicare-covered ambulance benefits.
    $185 copay for Medicare-covered ambulance benefits.
    ** Outpatient Medical Services and Supplies **
    Durable Medical Equipment
    Authorization rules may apply.
    20% of the cost for Medicare-covered durable medical equipment
    You may pay less if you purchase these items from the plan’s preferred manufacturers/vendors. Contact the plan for a list of non-preferred and preferred manufacturers/vendors.
    35% of the cost for Medicare-covered durable medical equipment
    Diagnostic Tests, X-Rays, Lab Services, and Radiology Services
    Authorization rules may apply.
    $15 copay for Medicare-covered lab services
    $15 copay for Medicare-covered diagnostic procedures and tests
    $15 copay for Medicare-covered X-rays
    20% of the cost for Medicare-covered diagnostic radiology services (not including X-rays)
    20% of the cost for Medicare-covered therapeutic radiology services
    If the doctor provides you services in addition to Outpatient Diagnostic Procedures Tests and Lab Services separate cost sharing of $25 to $40 may apply
    If the doctor provides you services in addition to Outpatient Diagnostic and Therapeutic Radiology Services separate cost sharing of $25 to $40 may apply
    20% of the cost for Medicare-covered therapeutic radiology services
    $15 copay for Medicare-covered outpatient X-rays
    20% of the cost for Medicare-covered diagnostic radiology services
    $15 copay for Medicare-covered diagnostic procedures tests and lab services
    ** Additional Benefits **
    Over-the-Counter Items
    The plan does not cover Over-the-Counter items.
    Transportation
    Authorization rules may apply.
    $0 copay for up to 6 one-way trip(s) to plan approved location every year
    $0 copay for transportation.




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    • When enrolling in a Medicare Advantage plan, you must continue to pay your Medicare Part B premium.
    • Medicare beneficiaries with higher incomes may be required to pay both a Medicare Part B and Medicare Part D Income Related Monthly Adjustment Amount (IRMAA). Read more on IRMAA.
    • Medicare Advantage plans that include prescription drug coverage (MAPDs) are considered Medicare Part D plans and members with higher incomes may be subject to the Medicare Part D Income Related Monthly Adjustment Amount (IRMAA), just as members in stand-alone Part D plans. In certain situations, you can appeal IRMAA.
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    • If you are enrolled in a Medicare plan with Part D prescription drug coverage, you may be eligible for financial Extra Help to assist with the payment of your prescription drug premiums and drug purchases. 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 consult www.medicare.gov; the Social Security Office at 1-800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday. TTY users should call, 1-800-325-0778; or your state Medicaid Office.
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    • A Medicare Advantage Private Fee-for-Service plan (PFFS) is not a Medicare supplement plan. Providers who do not contract with the plan are not required to see you except in an emergency.
    • Disclaimer for Institutional Special Needs Plan (SNP): This plan is available to anyone with Medicare who meets the Skilled Nursing Facility (SNF) level of care and resides in a nursing home.
    • Disclaimer for Dual Eligible (Medicare/Medicaid) Special Needs Plan (SNP): This plan is available to anyone who has both Medical Assistance from the State and Medicare. Premiums, co-pays, co-insurance, and deductibles may vary based on the level of Extra Help you receive. Please contact the plan for further details.
    • Disclaimer for Chronic Condition Special Needs Plan (SNP): This plan is available to anyone with Medicare who has been diagnosed with the plan specific Chronic Condition.
    • Medicare MSA Plans combine a high deductible Medicare Advantage Plan and a trust or custodial savings account (as defined and/or approved by the IRS). The plan deposits money from Medicare into the account. You can use this money to pay for your health care costs, but only Medicare-covered expenses count toward your deductible. The amount deposited is usually less than your deductible amount, so you generally have to pay out-of-pocket before your coverage begins.
    • Medicare MSA Plans do not cover prescription drugs. If you join a Medicare MSA Plan, you can also join any separate (stand-alone) Medicare Part D prescription drug plan
    • There are additional restrictions to join an MSA plan, and enrollment is generally for a full calendar year unless you meet certain exceptions. Those who disenroll during the calendar year will owe a portion of the account deposit back to the plan. Contact the plan provider for additional information.
    • Medicare beneficiaries may enroll through the CMS Medicare Online Enrollment Center located at www.medicare.gov.
    • Medicare beneficiaries can file a complaint with the Centers for Medicare & Medicaid Services by calling 1-800-MEDICARE 24 hours a day/7 days or using the medicare.gov site. Beneficiaries can appoint a representative by submitting CMS Form-1696.
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