FAQ's

1. Do I Need Medicare A & B To Enroll Into Your Medicare Advantage with a Part D Prescription Plan?
Yes. To be eligible to elect a Medicare Advantage Plan an individual must be entitled to Medicare Part A and enrolled in Part B, and must be entitled to Medicare Part A and Part B benefits as of the effective date of coverage under the plan. You must continue to pay the monthly Medicare Part B premium.

2. When Can I Enroll Into Your Medicare Advantage Plan?
There are four types of election periods during which individuals may make enrollment requests. They are:

Annual Election Period (AEP)
During the Annual Election Period, Medicare Advantage eligible individuals may enroll in or disenroll from a Medicare Advantage plan. The Annual Election Period occurs November 15 through December 31 every year. During this time, if you wish, you may add or drop Part D prescription drug coverage.
Initial Coverage Election Period (ICEP)
The Initial Enrollment Period for Part B is the seven (7) month period that begins three (3) months before the month an individual meets the eligibility requirements for Part B, and ends three (3) months after the month of eligibility.
Open Enrollment Period (OEP)
The Open Enrollment Period starts January 1 and ends March 31. During this time you are given the opportunity to change Medicare Advantage plans. You can only make one change and you may not add or drop Part D prescription drug coverage.
Special Election Period (SEP)
There are certain situations that would entitle a Medicare beneficiary to make changes at other times during the year. Following are examples of these situtations: change in residence, leaving or dropping employer group coverage, losing or recently becoming eligible for VA benefits, full or partial dual eligibles or Low Income Subsidy (LIS).

3. Are There Pre-Existing Conditions?
Except under special conditions, an individual is not eligible to elect a Medicare Advantage plan if he/she has been medically determined to have End-Stage Renal Disease (ESRD). Please call us for more information.

4. Do I Give Up My Medicare By Joining Your Medicare Advantage Plan?
No. You keep your Medicare card but The Health Plan/THP will issue you an identification card to use during visits to your physicians or hospital. Keep your Medicare card in a safe place if you decide to go back to Original Medicare.

5. What If I Move Out Of The Area?
Our contract with Medicare requires you to live inside our service area. Medicare allows you to leave our service area for no more than six (6) consecutive months. If you are moving outside of the service area you must tell us in writing so we can disenroll you. You will then be covered under Original Medicare.

6. What If I Already Belong To Another Medicare Advantage Plan?
If you choose to enroll into The Health Plan/THP Medicare Advantage Plan, your coverage from your current Medicare Advantage Plan will automatically be terminated. Medicare only allows you to be enrolled into one Medicare Advantage Plan at a time.

7. Do I Need To Choose A Primary Care Physician (PCP) And Can I Change My PCP At Any Time?
Yes. You need to choose a PCP from our list of contracted providers if you are choosing our Medicare Advantage Plan, SecureCare. You can change your PCP once a month. Call Customer Service in the Ohio Valley/Mountaineer Region at 1.877.847.7907 or the HomeTown Region at 1.877.236.2296 to make the change.

8. What Is The Difference Between A Medigap Policy And A Medicare Advantage Plan?
A Medigap policy is Medicare Supplement Insurance sold by private insurance companies to fill the "gaps" in Original Medicare Plan coverage. These policies help pay some of the healthcare costs that the Original Medicare Plan doesn't cover. Whatever Medicare doesn't cover, typically a Medigap plan will pick up.

Medicare Advantage Plans are health options that are part of the Medicare program. If you join one of these plans, you generally get all of your Medicare-covered healthcare through that plan with lower copayments. You may have to see doctor's that belong to the plan or go to certain hospitals to get service. This coverage can include prescription drug coverage.

9. What is the Difference Between a Medical Emergency and Urgently Needed Care?
The two main differences between urgently needed care and a medical emergency are in the danger to your health and your location. A "medical emergency" occurs when you reasonably believe that your health is in serious danger, whether you are in or outside of the service area. "Urgently needed care" is when you need medical help for an unforeseen illness, injury, or condition but your health is not in serious danger and you are generally outside of the service area. Under unusual and extraordinary circumstances, care may be considered urgently needed and paid for by The Health Plan/THP when you are in the service area, but the provider network is temporarily unavailable or inaccessible.

10. What Is The Difference Between Traditional Medicare And Medicare Prescription (Part D) Coverage?
Original Medicare Part A and B covers hospitalization and outpatient medical services. Prescription Drug coverage was not included in the Original Medicare plan. The Medicare Part D prescription plan was started in January of 2006 which allows individuals to receive a prescription drug benefit through the Medicare program. Medicare Part D prescription drug coverage is administered through private insurance companies and may or may not be included in a Medicare Advantage plan.

11. What Happens To My Medicare Card If I Enroll In A Medicare Advantage Plan?
You can keep your Medicare card. A Health Plan/THP card will be sent to individuals who join our Medicare Advantage Plan to be used when receiving medical, vision and/or prescription services.

12. What Is Creditable Coverage?
This is coverage that is on average, at least as good as the standard Medicare prescription drug coverage as outlined by the government.

13. What If I Already Receive Prescription Drug Coverage As Part Of My Employer's Retiree Benefits?
You decide what is best for you. If an employer or union offers prescription drug benefits, you should compare the plan and costs with those offered under The Health Plan/THP prescription drug plans. It is an employer's responsibility to inform their Medicare eligible retirees/employees if the prescription drug plan offered is considered to be creditable coverage. This means the coverage is on average, at least as good as the standard Medicare Part D benefit.

Note: If your retiree plan is not considered "creditable coverage" and you choose not to purchase a Medicare Part D prescription drug plan, your may have to pay more each month (a penalty) if you want to join a Medicare Part D prescription plan later. Also, if your employer coverage has a Medicare Part D prescription drug plan, your enrollment in a Health Plan/THP Medicare Advantage plan will automatically cancel your employer coverage even if you choose one of our plans without Part D prescription drug coverage.

14. Will My Prescriptions Be Covered If I Have Coverage Through the Veteran’s Administration (VA)?
VA benefits will not be affected. Medicare beneficiaries who currently have prescription drug benefits through the VA will be able to continue to obtain their prescriptions through the VA coverage.

15. What If I Am Traveling And Need To Fill A Covered Prescription?
You can fill a prescription at any of the pharmacies participating in the The Health Plan/THP network, no matter where they are in the United States. Also, you may choose to use our mail order service offered through Medco.

16. Are Prescriptions Covered In Canada?
No. Only drugs sold within the United States may be covered under the Medicare prescription drug plan.

17. To Help Save Money Do You Offer Prescriptions By Mail?
Yes. If you take medications on an ongoing basis, using mail order service to receive your prescriptions will result in a cost savings for you. You can receive a 90-day supply of your covered medications for two (2) copays instead of three and using the mail order service could result in a savings for the actual cost of the medication.

18. What Are Your Drug Copays And Do You Offer Coverage Through The Gap?
The Health Plan/THP 2009 drug copays are:

Generics (Tier 1) - $7 Retail for 30-day supply at the retail pharmacy; $14 for a 90-day supply through mail order
Preferred Brand (Tier 2) - $30 Retail for 30-day supply at the retail pharmacy; $60 a for 90-day supply through mail order
Non-Preferred Brand (Tier 3) – 50%
Generic drugs are covered through the coverage gap.

19. How Can I Find Out If My Drugs Are Covered?
Visit Medicare RX. For more information, call Customer Service in the Ohio Valley/Mountaineer Region at 1.877.847.7915 or in the HomeTown Region at 1.877.236.2290.

20. Do I Need A Medicare Prescription Drug Plan?
The Medicare prescription drug program is completely voluntary. If you want Medicare Part D prescription drug coverage, you can choose to enroll with The Health Plan/THP . There could be a penalty if you do not join during your initial enrollment period. The penalty is 1% for every month you were eligible but did not enroll. The exception is if you have creditable coverage, meaning you have a plan that is on average, at least as good as the standard Medicare Part D prescription drug coverage.

21. What Is My Monthly Premium?
Your 2009 monthly premium for the following plans in the HomeTown Region is:

SecureCare Medicare Advantage (HMO) without Medicare Part D prescription drug coverage - $0
SecureCare Medicare Advantage (HMO) with Medicare Part D prescription drug coverage - $20
SecureChoice Medicare Advantage (PPO) without Medicare Part D prescription drug coverage - $20
SecureChoice Medicare Advantage (PPO) with Medicare Part D prescription drug coverage - $40
SecureFreedom Medicare Advantage (PFFS) without Medicare Part D prescription drug coverage - $40
SecureFreedom Medicare Advantage (PFFS) with Medicare Part D presciption drug coverage - $95

Your 2009 monthly premium for the following plans in the Ohio Valley/Mountaineer Region is:

SecureCare Medicare Advantage (HMO) without Medicare Part D prescription drug coverage - $0
SecureCare Medicare Advantage (HMO) with Medicare Part D prescription drug coverage - $55
SecureChoice Medicare Advantage (PPO) without Medicare Part D prescription drug coverage - $20
SecureChoice Medicare Advantage (PPO) with Medicare Part D prescription drug coverage - $75
SecureFreedom Medicare Advantage (PFFS) without Medicare Part D prescription drug coverage - $40
SecureFreedom Medicare Advantage (PFFS) with Medicare Part D prescription drug coverage - $95

If you are currently receiving extra help with your prescriptions through the government, the Medicare Part D premium amount that you pay as a member of The Health Plan/THP will vary based on Medicare guidelines.

For more information, call Customer Service in the Ohio Valley/Mountaineer Region at 1.877.847.7915 or in the HomeTown Region at 1.877.236.2290.

22. Is Extra Help Available For My Prescriptions?
If you have limited income and resources you may qualify for extra help to cover prescriptions in one of two ways:

You automatically qualify for extra help and don't need to apply. This applies if you have full coverage from a state Medicaid program, get help from Medicaid paying your Medicare premiums or get Supplemental Security Income benefits. Medicare will mail a letter to those who automatically qualify for extra help.

You apply and qualify for extra help. If you think you qualify, call Social Security at 1.800.772.1213 or visit their website at www.socialsecurity.gov . You may also be able to apply at your State Medicaid office. After you apply you will be notified by mail letting you know if you have been accepted and what to do next.

23. Do I Have Any Deductibles To Pay?
No, all of your Medicare deductibles will be covered. If you enroll in the THP SecureChoice (PPO) Medicare Advantage plan and choose to go out-of-network to seek care or treatment you may be subject to a $250 deductible.

24. Do I Have An Out-Of-Pocket Maximum?
Yes, the annual out-of-pocket maximum is the limit to how much you may have to pay out-of-pocket in the form of copays and/or coinsurance amounts for covered healthcare services each year. Once your total costs for covered healthcare services, excluding outpatient drugs, reaches the specific plan's annual out-of-pocket maximum, then you won't have to pay for covered medical services for the remainder of the calendar year. You will still continue to pay for your Part D prescription drugs.

25. How Do I Pay My Monthly Premium?
You have three ways to pay your premium:

- You can pay your monthly premium directly to The Health Plan/THP with coupons which we will mail to you or you can drop off a check at our office.
- You can have your monthly premium deducted from your checking or savings account.
- You can have your monthly plan premium directly deducted from your monthly Social Security check.

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