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2012 Plan Year Options

Notices & Disclaimers

A Coordinated Care plan with a Medicare Advantage contract.

The benefit information provided herein is a brief summary, not a comprehensive description of benefits. For more information contact the plan.

Benefits, formulary, pharmacy network, premium and/or copayments/coinsurance may change on January 1, 2013.

Individuals must have both Part A and Part B to enroll. You must continue to pay your Medicare Part B premium.

Limitations, copayments and restrictions may apply.

You may be able to get Extra Help to pay for your prescription drug premiums and costs. 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;
• 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.

People with limited incomes may qualify for Extra Help to pay for their prescription drug costs. If you qualify, Medicare could pay up to seventy-five (75) percent or more of your drug costs including monthly prescription drug premiums, annual deductibles and coinsurance. 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. For more information about this Extra Help, contact your local Social Security office or call 1-800-MEDICARE (1-800-633-4227), 24 hours per day, 7 days per week. TTY users should call 1-877-486-2048.

You may enroll in the plan only during specific times of the year. Contact us for more information. You can enroll at any time in a Dual Eligbile SNP. You must have both Part A and Part B to enroll.

Documents are available for free in alternate formats or languages. For more information, contact our Customer Service Department. 

Puede acceder gratuitamente a los documentos en formatos o idiomas alternativos. Para obtener más información, comuníquese con nuestro Departamento de Servicios al Usuario.

Eligible beneficiaries must use network pharmacies to access their prescription drug benefit except under non-routine circumstances, and quantity limitations and restrictions may apply.

Members in our HMO plans 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 Coventry Health Care (and all subsidiaries) will be responsible for the costs.

Members in our PPO/POS plans can go to doctors, specialists or hospitals in- or out-of-network. With the exception of emergency or urgent care, it may cost more to get care from out-of-network providers.

Dual-eligible Special Needs Plans are available to anyone who has both Medical Assistance from the state and Medicare. Premiums, copays, coinsurance and deductibles may vary based on the level of Extra Help that you receive. Please contact the plan for further details.

The Medicare program rates how well plan sponsors perform in different categories (for example, detecting and preventing illness, ratings from patients, patient safety and customer service and other measures). To find plan ratings information go to http://www.medicare.gov and select "Health & Drug Plans" on the left navigation to compare the plan ratings for Medicare plans in your area. You can also call us directly at 1-877-982-9123 ( TTY users may call 711) to obtain a copy of the plan ratings for this plan.

This is not a complete listing of plans available in your service area. For a complete listing please contact 1-800-MEDICARE (TTY users should call 1-877-486-2048), 24 hours a day/7 days a week or consult www.medicare.gov. Medicare beneficiaries may enroll through the CMS Medicare Online Enrollment Center located at http://www.medicare.gov.