Medicare Advantage Eligibility Requirements
Anyone entitled to Medicare Part A and enrolled in Part B may apply for Health Net's Medicare Advantage (MA) plans. Medicare beneficiaries can only enroll in these plans during certain times of the year and must continue to pay their Medicare Part B premiums. Applicants must also reside in the plan's service area.
The Medicare prescription drug benefit is only available to members who are enrolled in a
Health Net Medicare Advantage with Part D (MA-PD) plan. Eligible Medicare beneficiaries enrolled in Health Net's MA-PD plans must use network pharmacies to receive their pharmacy benefits (except under non-routine circumstances when you cannot reasonably use network pharmacies).
Beneficiaries who are already enrolled in a Health Net MA-PD plan must receive their Medicare prescription drug benefits through that plan and can only be enrolled in one MA-PD plan at a time. Beneficiaries enrolled in an MA Plan may not enroll in a PDP, unless they are a member of a Private Fee-for-Service MA Plan (PFFS) that does not provide Medicare prescription drug coverage, or an 1876 Cost Plan.
Important Part D Information
Part D is a Prescription Drug Plan that the government has created for people who are eligible for Medicare. However, Part D does not operate the same as Parts A and B, as it is not available from the government. It can only be accessed through a private insurance carrier, like Health Net.
This benefit is available to you in a number of ways: either combined with medical coverage in a Medicare Advantage Prescription Drug Plan, or as a separate prescription drug plan which supplements original Medicare or a Medigap plan.
To get coverage, start by choosing a health insurance company. Each company's plans will vary, so choose a plan that works best for you.
Low Income Subsidy (LIS) Inquiries
People with limited incomes may qualify for extra help to pay for their prescription drug costs. If you qualify, Medicare could pay for 75% or more of your drug costs including monthly prescription drug premiums, annual deductibles, and co-insurance. Additionally, those who qualify won't have a 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 a day, 7 days a week. TTY users should call 1-877-486-2048.
If you qualify for extra help with your Medicare prescription drug coverage costs, Medicare will pay all or part of your plan premium. If Medicare pays only a portion of this premium, we will bill you for the amount that Medicare doesn't cover.
Contract Renewal and Termination Procedures
All Medicare Advantage Plans agree to stay in the program for a full calendar year at a time. Plan benefits and cost-sharing may change from calendar year to calendar year. Each year, plans can decide whether to continue to participate with Medicare Advantage. A plan may continue in their entire service area (geographic area where the plan accepts members) or choose to continue only in certain areas. Also, Medicare may decide to end a contract with a plan. Even if your Medicare Advantage Plan leaves the program, you will not lose Medicare coverage. If a plan decides not to continue for an additional calendar year, it must send you a letter at least 90 days before your coverage will end. The letter will explain your options for Medicare coverage in your area.
Need More Information?
The benefits described on the Health Net website are only a summary for informational purposes. It is not a contract. The actual complete terms and conditions of the health plan can be found in the Evidence of Coverage (EOC) document.
For full information on a specific plan's benefits, including information on premium withhold or direct bill options, other exclusions, limitations, or restrictions to services not already identified in this section, and how to obtain this material in an alternate format, please Contact Us.