Explaining your senior health plan prescription rights.
As a member of CareMore's Health Plan you have little to worry about when it comes to Prescription Drug coverage especially when you consider your benefits. At CareMore:
- We have No Part D deductible
- We offer Brand Name and Generic Drugs
Below, you will find details about Part D. Of course, if you have questions, you can always contact us for explanations and clarifications.
Here's your guide to Medicare's prescription drug coverage.
As of January 1, 2006, Medicare began offering prescription drug coverage (Part D) to all Medicare beneficiaries. Medicare beneficiaries, who want to participate in Part D coverage, must choose a stand along prescription Part D plan or a health plan that includes Part D coverage. All plans offered by CareMore include Part D coverage. CareMore's plans have a variety of benefits with different costs to help meet your specific needs.
Frequently Asked Questions
What is the Medicare prescription drug coverage?
Medicare prescription drug coverage, referred to as "Medicare Part D", is a type of insurance program that provides prescription drug benefits for Medicare beneficiaries.
Who can participate?
Effective January 1, 2006, all Medicare beneficiaries are eligible for Medicare prescription drug coverage.
How much will I save if I enroll in a Medicare prescription drug plan?
Your savings will depend on both the particular types of prescriptions your doctors have recommended and your specific financial situation. For example, people with very limited incomes and resources generally save more. However, most enrollees will save money under Medicare's prescription drug plan. Please contact CareMore at (1-800-499-2793) for specific examples.
I have limited income. Is there extra help for me?
There is help available for people with a limited income and/or resources. If you have any questions about your qualifications for need help determining if you qualify, please contact Medicare directly at (1-800-Medicare or 1-800- 633-4227). You may find that part or all of your premiums and deductibles will be paid for you.
How do I find out if my medications are covered?
Each insurance plan has a specific list of covered prescription medications (a formulary) for their members. It is important that you review these lists before choosing the plan that is right for you.
CareMore Health Plans Online Formulary Search:
You can use the Online Formulary Search Tool link to search our formulary (drug list).
Can I delay enrolling?
All enrollment is voluntary. However, the government enacts a monthly premium penalty if you decide to enroll in any plan after you become eligible the first time or after the open enrollment period ends unless you meet certain exemption criteria.
Where can I get more information?
Call CareMore at 1-800-499-2793, 8AM-6PM PST, Monday - Friday
Look online at www.medicare.gov
Call Medicare directly at 1-800-MEDICARE (1-800-633-4227), 24 hours a day, 7 days a week
Call your State Health Insurance Assistance Program
For Arizona - Arizona State Health Insurance Assistance Program (SHIP) at 1-800-432-4040
For Nevada - Nevada State Health Insurance Assistance Program (SHIP) at 1-800-307-4444
For California - California State Health Insurance Assistance Program (HICAP) at 1-800-434-0222 or 1-213-383-4519
Contact community groups in your area for possible assistance
Please click below for the Prior Authorization Criteria document
For certain drugs, you or your provider need to get approval from the plan before we will agree to cover the drug for you. This is called "prior authorization". Sometimes the requirement for getting approval in advance helps guide appropriate use of certain drugs.
To request a Coverage Determination or Formulary Exception please print out the PDF document below. The Prescription Drug Coverage Determination Request form is optional and not necessary to request a coverage determination. You or your doctor (or other prescriber) can request a coverage determination by writing to us at Part D Exceptions, PO Box 407, Boys Town, NE 68010. By faxing the form to 1-866-632-7946 or by contacting our toll free number 1-800-546-5677 (TTY users should call 1-866-706-4757) 24 hours a day, seven days a week.
Coverage Determination Form for Members may be found here (PDF).