These two plans include Prescription Drug (Part D) benefits only — Essential (PDP) and Prime (PDP). The Summary of Benefits, Evidence of Coverage, and other information below explain the details about each plan.
Summary of Benefits — This booklet explains general information about our Essential and Prime options and compares them to original Medicare. It also includes information about premiums, cost sharing, out-of-network coverage, any limitations, and more:
|Essential/Prime Summary of Benefits|
Evidence of Coverage (EOC) — These documents provide the most detailed information about each plan:
|Essential EOC||Prime EOC|
The benefit information provided is a brief summary, not a comprehensive description of benefits. For more information contact the plan. Limitations, co-payments, and restrictions may apply. Benefits, formulary, pharmacy network, premium and/or copayments/co-insurance may change on January 1 of each year.
Availability of coverage beyond the end of the current contract year is not guaranteed. Members may enroll in these plans only during certain times of the year. Contact Health First Health Plans for more information. Individuals must have both Medicare Part A and Part B to enroll in the plan. You must continue to pay your Medicare Part B premium. Limitations, copayments, and restrictions may apply.
You must use network pharmacies to access your prescription drug benefit, except under non-routine circumstances. Quantity limitations 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 getting Extra Help, call:
People with limited incomes may qualify for Extra Help to pay for their prescription drug costs. If you qualify, Medicare could pay for up to seventy-five (75) percent or more 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. 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 can also contact Social Security or Medicaid to find out your LIS status or level.
Medicare beneficiaries may enroll in Health First Medicare Plans through the CMS Medicare Online Enrollment Center located at http://www.medicare.gov
This information is available for free in other languages. Please contact our Customer Service Department at 1-855-737-4347, or through TDD/TTY relay 1-800-955-8771 any day of the week from 8 am to 8 pm. Esta información está disponible de forma gratuita en otros idiomas. Comuníquese con nuestro Servicio al Cliente al 1-855-737-4347, TTY/TDD 1-800-955-8771 (lunes-domingo 8 am - 8 pm).
For more information on authorizations, eligibility, enrollment, pharmacies, prescriptions, or any other benefits, please contact Health First Health Plans Customer Service:
Y0089_MP3208 CMS Approved 12202012
Last updated: 12/3/2012