Answers to common questions about Advocare Medicare Advantage plans by Security Health Plan
 

Who is eligible?

• Anyone entitled to Medicare Part A and enrolled in Medicare Part B:
  • 65 years of age and older
  • Under 65 and disabled
• Individuals must live in the Advocare plans service area at least six months per year.
• Individuals may only enroll during specific times of the year, called enrollment periods. Please call Customer Service for more information at 1-877-998-0024 (TTY: 1-877-727-2232) from 8 a.m. to 8 p.m., seven days a week.

No medical underwriting is required (you are not eligible if you have end-stage renal disease [ESRD] unless you are currently a member of Security Health Plan, other than Medicare Select).

I know that I cannot join an Advocare plan if I have end-stage renal disease (ESRD) and I am receiving kidney dialysis. What if I develop ESRD after I am already a member?
You would continue to be covered with the same Advocare plan benefits you had before the ESRD diagnosis.
 

What happens to my Medicare coverage when I join an Advocare plan?
Enrolling in an Advocare plan simply means that you are allowing Security Health Plan to provide your Medicare benefits plus some additional coverage. You will continue to pay your Medicare Part B premium, but you will use your Advocare plan ID card to obtain health care services.

Can I go back to Original Medicare if I change my mind?
Yes, if this is the first Medicare Advantage plan you have enrolled in, you may return to Original Medicare any time within the first 12 months or during the next enrollment/disenrollment period.

Can I go back to a Medicare supplement (Medigap) policy?
Yes, if this is the first Medicare Advantage plan you have enrolled in, you may return to Original Medicare or your previous Medicare Supplement (Medigap) plan as long as it is still available. After the first 12 months, you may be required to go through medical underwriting and wait for an enrollment period.
 

How will health care reform affect my coverage?
Health care reform is intended to improve the quality of care in Medicare and reduce health care costs for beneficiaries. Many of the changes will positively affect members, including the reduction of the coverage gap for Part D prescription drug coverage. You can expect to continue to receive great coverage, reliable service and outstanding value from Security Health Plan for many years to come.

What if the government makes changes to the Medicare Advantage program?
The Medicare Advantage Program remains strong at about 10 million members nationwide. Security Health Plan has maintained its contract with Medicare (the federal government) since 2001 and plans to continue this relationship. If our contract is ever not renewed for any reason, we’ll tell you at least 90 days in advance. You may then switch to Original Medicare or another Medicare plan.

Will I need to get a physical and will my pre-existing conditions affect my eligibility? Do Advocare plans have waiting periods before coverage begins?
Security Health Plan's Advocare plans have no requirements for a physical, no pre-existing condition limitations (except ESRD) and no waiting periods. Security Health Plan does not ask any health questions other than if you have ESRD and are receiving kidney dialysis.

Will my premium increase with my age?
No. Your Advocare plan premium will not increase because of your age. All members pay the same monthly premium (the amount depends on the plan you choose). Your plan premium can increase only once a year, in January.

May I choose my own providers?
Yes. You can choose any provider in Security Health Plan's Advocare network without a referral. However, if you obtain routine care from out-of-network providers, neither Medicare nor Security Health Plan will be responsible for the costs. Please review the Provider & Pharmacy Directory for a list of network providers. You may also call Customer Service for a list of plan providers in your area.

What if I have an emergency when I’m out of the Advocare plans service area?
If you need emergency or urgent care, go to the nearest hospital or urgent care center. It doesn’t matter whether the provider is in the network or not. As soon as possible, make sure Security Health Plan is notified of your emergency.
 

Can I get help paying for my prescription drug costs?
People with limited incomes may qualify for extra help to pay for their prescription drug costs. If you are eligible, Medicare could pay for up to 100 percent of 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. To see if you qualify for extra help, contact your local Social Security office or call:

• 1-800-MEDICARE (1-800-633-4227). TTY or TDD users should call 1-877-486-2048, 24 hours a day/7 days a week;

or

• The Social Security Administration at 1-800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday. TTY or TDD users should call, 1-800-325-0778;

or

• Your State Medical Assistance (Medicaid) Office.

Do I have to enroll in Part D?
No. Enrollment in Part D is voluntary. However, if you do not have prescription drug coverage that meets Medicare's minimum standards and do not enroll in a Part D plan at the first opportunity but later choose to join, you may be subject to a higher premium based on a late enrollment penalty. You would be subject to the penalty for as long as you remain enrolled in Part D.

If I choose not to enroll in a Part D plan now, will I be able to enroll later?
Yes, during specific enrollment periods. Please call Customer Service for more information on enrollment periods at 1-877-998-0024 (TTY: 1-877-727-2232) from 8 a.m. to 8 p.m., seven days a week.

What if I already have prescription drug coverage?
If your current drug coverage meets Medicare’s minimum standards, you may keep that coverage and wait to enroll in Part D later if you choose, without being subject to a late enrollment penalty. The organization offering your current coverage, such as your former employer, union or the insurance company they have hired, will tell you whether your current coverage meets Medicare’s minimum standards. If your coverage does not meet Medicare’s minimum standards, you will be subject to a late enrollment penalty if you wait and enroll in a Medicare Part D prescription drug plan later.

What if I have a Part D plan currently and want to enroll in an Advocare plan?
You may enroll in an Advocare plan during specific enrollment periods. Your current Part D plan will be automatically canceled by the Centers for Medicare & Medicaid Services (CMS) when you enroll in an Advocare plan. You cannot have a separate Part D plan if you enroll in an Advocare plan with or without Part D. You must enroll in an Advocare plan that has Part D to get Part D prescription coverage when you have an Advocare plan – unless you have coverage through a creditable coverage plan. Please call Advocare Customer Service for more information on enrollment periods at 1-877-998-0024 (TTY: 1-877-727-2232) from 8 a.m. to 8 p.m., seven days a week.
 

What if I have a complaint or disagree with a decision regarding my coverage?
You may call Customer Service for any complaint or issue you may have with your coverage. We will always give you all the information you need and listen to your concerns. We also have appeals and grievance procedures to help members resolve problems. We review complaints about quality of care and Part D prescription drugs (grievances) within 30 days. Issues about payment for medical services (appeals) will be addressed within 60 days. If the appeal is for a denied medical service, the reconsideration decision must be made no later than 30 days after receipt. Issues about payment for Part D medications (appeals) will be addressed within 7 days. However, if your health is at stake, we are required to respond to medical and Part D appeals within 72 hours.
 

How do I enroll?
A sales agent representing Security Health Plan will be glad to help you complete an application. Call the number below.

After we receive your completed application and verify your information with CMS, we will send you an acknowledgement letter with your proposed effective date and Advocare plan ID card. If you are denied Advocare plan coverage, a letter explaining the reason for the denial will be sent to you.
 

Where can I get more information about Advocare plans?
To speak with someone about any of the Advocare Medicare Advantage plan benefits, including Advocare plan Part D prescription drug coverage, call: 1-877-998-0024 (TTY: 1-877-727-2232) between 8 a.m. and 8 p.m., seven days a week. 

Customer Guide - H5211_MC-778-0249-C-06-10 CMS Approved 09172010