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2012 Medicare Advantage Plan Benefit Details for the Advantra Freedom (PPO)
This is archive material for research purposes. Please see PDPFinder.com or MAFinder.com for current plans.

2012 Medicare Advantage Plan Details
Medicare Plan Name:Advantra Freedom (PPO)
Location:Stone, Missouri     Click to see other locations
Plan ID:H5509 - 015 - 0     Click to see other plans
Member Services:1-800-727-9712 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 Advantra Freedom (PPO) benefit details
— Medicare Plan Features —
Monthly Premium:$19.80 (see Plan Premium Details below)
Annual Deductible:$0
Annual Initial Coverage Limit (ICL):$2,930
Health Plan Type:Local PPO
Maximum Out-of-Pocket Limit for Parts A & B (MOOP):$5,500
Additional Gap Coverage?No additional gap coverage, only the Donut Hole Discount
Total Number of Formulary Drugs:3,328 drugsBrowse the Advantra Freedom (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:		$6.00$35.00$70.0033% 
• Number of Drugs per
  Tier:		16103741020324
Plan's Pharmacy Search:http://PharmacyLocator.coventry-medicare.com
Plan Offers Mail Order?Yes
Number of Members enrolled in this plan in (H5509 - 015):72 members
Plan’s Summary Star Rating: 3 out of 5 Stars.
• Customer Service Rating: 4 out of 5 Stars.
• Member Experience Rating: 2 out of 5 Stars.
• Drug Cost Accuracy Rating: 3 out of 5 Stars.
— 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
$19.8 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.gov/physician or www.medicare.gov/supplier. You can also call 1-800
$5 500 out-of-pocket limit. All plan services included.
$10 000 out-of-pocket limit. All plan services included.
** 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
This plan does not cover supplemental routine transportation.
** Important Information **
Premium and Other Important Information
$19.8 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.gov/physician or www.medicare.gov/supplier. You can also call 1-800
$5 500 out-of-pocket limit. All plan services included.
$10 000 out-of-pocket limit. All plan services included.
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
No limit to the number of days covered by the plan each hospital stay.
For Medicare-covered hospital stays:
Days 1 - 7: $250 copay per day
Days 8 - 90: $0 copay per day
$0 copay for additional hospital days
Except in an emergency your doctor must tell the plan that you are going to be admitted to the hospital.
20% of the cost for each hospital stay.
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.
For Medicare-covered hospital stays:
Days 1 - 7: $200 copay per day
Days 8 - 90: $0 copay per day
Except in an emergency your doctor must tell the plan that you are going to be admitted to the hospital.
20% of the cost 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 - 3: $0 copay per day
Days 4 - 20: $50 copay per day
Days 21 - 100: $100 copay per day
20% of the cost for each SNF stay.
Home Health Care
Authorization rules may apply.
$0 copay for Medicare-covered home health visits
$0 copay for 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
$20 copay for each primary care doctor visit for Medicare-covered benefits.
$20 copay for each in-area network urgent care Medicare-covered visit
$40 copay for each specialist visit for Medicare-covered benefits.
20% of the cost for each primary care doctor visit
20% of the cost for each specialist visit
Chiropractic Services
$20 copay for each Medicare-covered 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 or other qualified providers.
20% of the cost for chiropractic benefits.
Podiatry Services
$20 copay for each Medicare-covered visit
Medicare-covered podiatry benefits are for medically-necessary foot care.
20% of the cost for podiatry benefits.
Outpatient Mental Health Care
Authorization rules may apply.
$40 copay for each Medicare-covered individual therapy visit
$40 copay for each Medicare-covered group therapy visit
$40 copay for each Medicare-covered individual therapy visit with a psychiatrist
$40 copay for each Medicare-covered group therapy visit with a psychiatrist
$40 copay for Medicare-covered partial hospitalization program services
20% of the cost for Mental Health benefits with a psychiatrist
20% of the cost for Mental Health benefits
20% of the cost for partial hospitalization program services
Outpatient Substance Abuse Care
Authorization rules may apply.
$40 copay for Medicare-covered individual visits
$40 copay for Medicare-covered group visits
20% of the cost for outpatient substance abuse benefits.
Outpatient Services/Surgery
Authorization rules may apply.
$300 copay for each Medicare-covered ambulatory surgical center visit
$300 copay for each Medicare-covered outpatient hospital facility visit
20% of the cost for outpatient hospital facility benefits.
20% of the cost for ambulatory surgical center benefits.
Ambulance Services
Authorization rules may apply.
$150 copay for Medicare-covered ambulance benefits.
$150 copay for ambulance benefits.
Emergency Care
$65 copay for Medicare-covered emergency room visits
Worldwide coverage.
If you are admitted to the hospital within 72-hour(s) for the same condition you pay $0 for the emergency room visit.
Urgently Needed Care
$20 copay for Medicare-covered urgently-needed-care visits
Outpatient Rehabilitation Services
$40 copay for Medicare-covered Occupational Therapy visits
$40 copay for Medicare-covered Physical and/or Speech and Language Therapy visits
20% of the cost for Physical and/or Speech and Language Therapy visits
20% of the cost for Occupational Therapy benefits.
** Outpatient Medical Services and Supplies **
Durable Medical Equipment
Authorization rules may apply.
20% of the cost for Medicare-covered items
20% of the cost for durable medical equipment
Prosthetic Devices
Authorization rules may apply.
20% of the cost for Medicare-covered items
20% of the cost for prosthetic devices.
Diabetes Programs and Supplies
Authorization rules may apply.
$0 copay for Diabetes self-management training
$10 copay for Diabetes monitoring supplies
20% of the cost for Therapeutic shoes or inserts
If the doctor provides you services in addition to Diabetes self-management training separate cost sharing of $20 to $40 may apply
20% of the cost for Diabetes self-management training
20% of the cost for Diabetes monitoring supplies
20% of the cost for Therapeutic shoes or inserts
'Diagnostic Tests, X-Rays, Lab Services, and Radiology Services'
Authorization rules may apply.
$0 copay for Medicare-covered:
  • lab services
  • diagnostic procedures and tests
    • $0 copay for Medicare-covered X-rays
    $150 to $400 copay [or 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 $20 to $40 may apply
    If the doctor provides you services in addition to Outpatient Diagnostic and Therapeutic Radiology Services separate cost sharing of $20 to $40 may apply
    20% of the cost for therapeutic radiology services
    20% of the cost for outpatient X-rays
    20% of the cost for diagnostic radiology services
    20% of the cost for 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
    20% of the cost for Cardiac Rehabilitation Services
    20% of the cost for Intensive Cardiac Rehabilitation Services
    20% of the cost for Pulmonary Rehabilitation Services
    Preventive Services and Wellness/Education Programs
    $0 copay for all preventive services covered under Original Medicare at zero cost sharing:
  • Abdominal Aortic Aneurysm screening
  • Bone Mass Measurement
  • Cardiovascular Screening
  • Cervical and Vaginal Cancer Screening (Pap Test and Pelvic Exam)
  • Colorectal Cancer Screening
  • Diabetes Screening
  • Influenza Vaccine
  • Hepatitis B Vaccine
  • HIV Screening
  • Breast Cancer Screening (Mammogram)
  • Medical Nutrition Therapy Services
  • Personalized Prevention Plan Services (Annual Wellness Visits)
  • Pneumococcal Vaccine
  • Prostate Cancer Screening (Prostate Specific Antigen (PSA) test only)
  • Smoking Cessation (Counseling to stop smoking)
  • Welcome to Medicare Physical Exam (Initial Preventive Physical Exam)
    • HIV screening is covered for people with Medicare who are pregnant and people at increased risk for the infection including anyone who asks for the test. Medicare covers this test once every 12 months or up to three times during a pregnancy. Please contact plan for details.
    The plan covers the following supplemental education/wellness programs:
  • Nutritional benefit
  • Health Club Membership/Fitness Classes
  • Nursing Hotline
    • 20% of the cost for Medicare-covered preventive services
    $50 copay for supplemental education/wellness programs
    Kidney Disease and Conditions
    Authorization rules may apply.
    $0 copay for renal dialysis
    $0 copay for kidney disease education services
    20% of the cost for kidney disease education services
    20% of the cost for renal dialysis
    Outpatient Prescription Drugs
    20% of the cost for Part B-covered chemotherapy drugs and other Part B-covered drugs.
    20% of the cost for Part B drugs out-of-network.
    This plan uses a formulary. The plan will send you the formulary. You can also see the formulary at www.KSFormulary.coventry-medicare.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 Advantra Freedom (PPO) for certain drugs.
    The plan will pay for certain over-the-counter drugs as part of its utilization management program. Some over-the-counter drugs are less expensive than prescription drugs and work just as well. Contact the plan for details.
    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 Advantra Freedom (PPO) approves the exception you will pay Tier 3: Non-Preferred Brand Drugs cost sharing for that drug.
    $0 deductible.
    You pay the following until total yearly drug costs reach $2 930:
    Tier 1: Preferred Generic Drugs
    Tier 2: Preferred Brand Drugs
    Tier 3: Non-Preferred Brand Drugs
    Tier 4: Specialty Tier Drugs
  • $6 copay for a one-month (30-day) supply of drugs in this tier
  • $35 copay for a one-month (30-day) supply of drugs in this tier
  • $70 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
  • $18 copay for a three-month (90-day) supply of drugs in this tier
  • $105 copay for a three-month (90-day) supply of drugs in this tier
  • $210 copay for a three-month (90-day) supply of drugs in this tier
    • Not all drugs on this tier are available at this extended day supply. Please contact the plan for more information.
    Not all drugs on this tier are available at this extended day supply. Please contact the plan for more information.
    Not all drugs on this tier are available at this extended day supply. Please contact the plan for more information.
    Tier 1: Preferred Generic Drugs
    Tier 2: Preferred Brand Drugs
    Tier 3: Non-Preferred Brand Drugs
    Tier 4: Specialty Tier Drugs
  • $6 copay for a one-month (31-day) supply of drugs in this tier
  • $35 copay for a one-month (31-day) supply of drugs in this tier
  • $70 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
    • Tier 1: Preferred Generic Drugs
    Tier 2: Preferred Brand Drugs
    Tier 3: Non-Preferred Brand Drugs
  • $6 copay for a one-month (30-day) supply of drugs in this tier
  • $35 copay for a one-month (30-day) supply of drugs in this tier
  • $70 copay for a one-month (30-day) supply of drugs in this tier
  • $18 copay for a three-month (90-day) supply of drugs in this tier
  • $105 copay for a three-month (90-day) supply of drugs in this tier
  • $210 copay for a three-month (90-day) supply of drugs in this tier
    • Not all drugs on this tier are available at this extended day supply. Please contact the plan for more information.
    Not all drugs on this tier are available at this extended day supply. Please contact the plan for more information.
    Not all drugs on this tier are available at this extended day supply. Please contact the plan for more information.
    After your total yearly drug costs reach $2 930 you receive a discount on brand name drugs and pay 86% of the plan's costs for all generic drugs until your yearly out-of-pocket drug costs reach $4 700.
    After your yearly out-of-pocket drug costs reach $4 700 you pay the greater of:
  • 5% coinsurance or
  • $2.60 copay for generic (including brand drugs treated as generic) and a $6.50 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 Advantra Freedom (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 $2 930:
    Tier 1: Preferred Generic Drugs
    Tier 2: Preferred Brand Drugs
    Tier 3: Non-Preferred Brand Drugs
    Tier 4: Specialty Tier Drugs
  • $6 copay for a one-month (30-day) supply of drugs in this tier
  • $35 copay for a one-month (30-day) supply of drugs in this tier
  • $70 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 not be reimbursed for the difference between the Out-of-Network Pharmacy charge and the plan's In-Network allowable amount.
    You will be reimbursed up to 14% of the plan allowable cost for generic drugs purchased out-of-network until total yearly out-of-pocket drug costs reach $4 700. You will be reimbursed up to the discounted price for brand name drugs purchased out-of-network until your total yearly out-of-pocket drug costs reach $4 700.
    You will not be reimbursed for the difference between the Out-of-Network Pharmacy charge and the plan's In-Network allowable amount.
    After your yearly out-of-pocket drug costs reach $4 700 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
  • $2.60 copay for generic (including brand drugs treated as generic) and a $6.50 copay for all other drugs.
    • You will not be reimbursed for the difference between the Out-of-Network Pharmacy charge and the plan's In-Network allowable amount.
    Dental Services
    In general preventive dental benefits (such as cleaning) not covered.
    $40 to $300 copay for Medicare-covered dental benefits
    20% of the cost for comprehensive dental benefits
    Hearing Services
    In general supplemental routine hearing exams and hearing aids not covered.
  • $20 copay for Medicare-covered diagnostic hearing exams
    • 20% of the cost for hearing exams.
    ** Additional Benefits **
    Vision Services
    $0 copay for
  • one pair of eyeglasses or contact lenses after cataract surgery
  • glasses
  • lenses
  • frames
  • $0 to $40 copay for exams to diagnose and treat diseases and conditions of the eye.
  • $0 copay for up to 1 supplemental routine eye exam(s) every year
    • If the doctor provides you services in addition to eye exams separate cost sharing of $40 may apply
    20% of the cost for eye exams.
    $0 copay for eye wear.
    $100 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
    This plan does not cover supplemental routine transportation.
    Acupuncture
    This plan does not cover Acupuncture.
    ** Inpatient Care **
    Inpatient Hospital Care
    No limit to the number of days covered by the plan each hospital stay.
    For Medicare-covered hospital stays:
    Days 1 - 7: $250 copay per day
    Days 8 - 90: $0 copay per day
    $0 copay for additional hospital days
    Except in an emergency your doctor must tell the plan that you are going to be admitted to the hospital.
    20% of the cost for each hospital stay.
    ** Outpatient Care **
    Doctor Office Visits
    $20 copay for each primary care doctor visit for Medicare-covered benefits.
    $20 copay for each in-area network urgent care Medicare-covered visit
    $40 copay for each specialist visit for Medicare-covered benefits.
    20% of the cost for each primary care doctor visit
    20% of the cost for each specialist visit
    Outpatient Services/Surgery
    Authorization rules may apply.
    $300 copay for each Medicare-covered ambulatory surgical center visit
    $300 copay for each Medicare-covered outpatient hospital facility visit
    20% of the cost for outpatient hospital facility benefits.
    20% of the cost for ambulatory surgical center benefits.
    Ambulance Services
    Authorization rules may apply.
    $150 copay for Medicare-covered ambulance benefits.
    $150 copay for ambulance benefits.
    ** Outpatient Medical Services and Supplies **
    Durable Medical Equipment
    Authorization rules may apply.
    20% of the cost for Medicare-covered items
    20% of the cost for durable medical equipment
    'Diagnostic Tests, X-Rays, Lab Services, and Radiology Services'
    Authorization rules may apply.
    $0 copay for Medicare-covered:
  • lab services
  • diagnostic procedures and tests
    • $0 copay for Medicare-covered X-rays
    $150 to $400 copay [or 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 $20 to $40 may apply
    If the doctor provides you services in addition to Outpatient Diagnostic and Therapeutic Radiology Services separate cost sharing of $20 to $40 may apply
    20% of the cost for therapeutic radiology services
    20% of the cost for outpatient X-rays
    20% of the cost for diagnostic radiology services
    20% of the cost for diagnostic procedures tests and lab services
    ** Additional Benefits **
    Over-the-Counter Items
    The plan does not cover Over-the-Counter items.
    Transportation
    This plan does not cover supplemental routine 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.
    • You must be enrolled in both Medicare Part A and Part B to enroll in a Medicare Advantage plan. Members may enroll in a Medicare Advantage plan only during specific times of the year. Contact the Medicare plan for more information.
    • 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.
    • Medicare evaluates plans based on a 5-Star rating system. Star Ratings are calculated each year and may change from one year to the next.
    • 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.
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    • 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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