Medicare Part D Plans (2012)

A stand-alone prescription drug plan with a Medicare contract

The benefit information provided herein 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, 2013.

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:

• 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048, 24 hours a day/7days a week;
• The Social Security Administration 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 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 number at 1-855-737-4347 for additional information.

Este documento puede estar disponible en un formato o idioma diferente. Para obtener información adicional, llame a Servicios de Miembros al número de teléfono indicado anteriormente. Si usted tiene necesidades especiales, este documento podría estar disponible en otros formatos.

More information

For more information on authorizations, eligibility, enrollment, pharmacies, prescriptions, or any other benefits, please contact Health First Health Plans Customer Service:

• Call weekdays from 8 am to 8 pm and Saturday from 8 am to noon: toll-free 1-855-737-4347, or through TDD/TTY relay 1-800-955-8771.
• Visit our office weekdays from 8 am to 5 pm or write to us at 6450 US Highway 1, Rockledge, FL 32955.

S0223_MP0018 CMS Approved 10202011
Last updated: 2/15/2012