Medicare Advantage frequently asked questions (FAQ)
Answers to some of the more common questions about Medicare and Bright HealthCare.
You qualify for premium-free Medicare Part A if you have reached the age of 65, are a U.S. citizen (or legal permanent resident who has been in the US for at least the last five years), and if you or your spouse (deceased or alive) paid Medicare taxes for at least ten years.
Medicare is a federal health insurance program that provides benefits to U.S. citizens and permanent legal residents (of at least five continuous years) aged 65 and older, or who have a qualifying disability or illness. It is made up of four distinct parts, Part A, Part B, Part C, and Part D. Learn more about the parts of Medicare.
Original Medicare is health coverage offered through the federal government, while Medicare Advantage plans are offered through private companies like Bright HealthCare. Another key difference is Original Medicare does not include an out-of-pocket maximum limit per year or provide coverage for prescription drugs, extra dental, vision or hearing care.
The Extra Help program provides assistance paying for your premium and prescription drugs. Depending on your financial situation and selected plan, you could pay as little as $0 for your monthly premium. Get more details on financial assistance for Medicare.
Choosing the right plan
Some people are automatically enrolled in Original Medicare (Parts A & B), and the remaining choices often come down to financial and coverage preferences. A Medicare Advantage (Part C) plan can include prescription coverage, and has an out-of-pocket maximum that gives members an easier way to budget annual healthcare costs. Get a better idea of which plans might work best for you here.
Drug coverage is an option for everyone with Medicare eligibility. It’s considered an additional benefit and not required. You are able to enroll in a prescription drug plan separately or as part of a Medicare Advantage plan. If you have prescriptions, drug coverage is likely a valuable addition for your plan. You can use our online tool to estimate your drug costs.
Enrolling in a Medicare plan
AEP runs from October 15 to December 7 each year. During this time, all Medicare eligible individuals can change plans or enroll in Medicare for the first time, if they missed doing so during their initial enrollment period.
Outside of AEP, there are a few other opportunities to enroll or disenroll in a Medicare plan.
- Initial Enrollment Period (IEP): This is a window of time that starts three months before your 65th birthday and continues for three months after your birthday.
- Special Enrollment Period (SEP): Available when life changes or special circumstances occur outside of AEP that result in needing to change your current health plan. Learn more about SEP.
- Open Enrollment Period (OEP): Medicare eligible persons can make “like plan” changes from January 1 - March 31. During this 3-month window, you can add or drop Part D coverage, or disenroll from a plan. Learn more about disenrolling.
Medicare Advantage coverage
This depends on your selected plan. All Bright HealthCare plans provide essential coverage for activities like visits to a primary care provider, visits to specialists, and preventive care. For complete coverage, view your Summary of Benefits, which is available as an online resource. Just select your plan and view attached resources.
A PCP is the main healthcare provider you see for routine and preventive care or common medical problems. Most often your doctor, the PCP, may also be a nurse practitioner or physician assistant.
In-network means that the provider or facility has an agreement with Bright HealthCare, and that visits and services are covered as described in the terms of your plan. If you are a Bright HealthCare member and receive care out-of-network, the costs may not be covered. You can search for in-network providers and facilities online.
Yes. Several Bright HealthCare Medicare Advantage plans include out-of-network benefits to provide additional flexibility for our members. View plan details or your Summary of Benefits for specifics on OON coverage.
Bright HealthCare is committed to helping you access the care you need in times of natural disasters and emergencies. In the event of a Presidential emergency declaration, a Presidential (major) disaster declaration, a declaration of emergency or disaster by a Governor, or an announcement of a public health emergency by the Secretary of Health and Human Services, Bright HealthCare will:
- allow access to Part A and Part B and supplemental Part C plan benefits at specified non-contracted facilities;
- waive in full requirements for gatekeeper referrals, where applicable;
- temporarily reduce plan-approved out-of-network cost-sharing to in-network cost-sharing amounts;
- waive the 30-day notification requirement to members as long as all the changes (such as reduction of cost-sharing and waiving authorization) benefit the member; and
- lift restrictions on refills of Part D prescription drugs so that members are able to fill medications sooner than usual.
The above actions will remain in effect through the emergency declaration period. Typically, the source that declared the disaster or emergency will clarify when it is over. If, however, the disaster or emergency timeframe has not been closed 30 days from the initial declaration, and if the Centers for Medicare & Medicaid Services (CMS) has not indicated an end date to the disaster or emergency, Bright HealthCare will resume normal operations 30 days from the initial declaration or such longer time as may be required by law, regulation or the underlying circumstances.
If you are impacted by one of the above events and need access to prescription drugs, please have your pharmacy contact the PBM’s Pharmacy Help Desk (the number is listed on the back of your Member ID card). Pharmacy Help Desk agents will be authorized to override early refill edits for the days supply requested by the pharmacy, as available at time of refill, up to the maximum Extended Days Supply defined by the plan, regardless of location at which the beneficiary is attempting to obtain a refill. For questions about accessing medical care, please call the Bright HealthCare Member Services number listed on the back of your Member ID card.
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Website Last Updated: Jan 13 2021