Medicare Advantage frequently asked questions (FAQ)

Answers to some of the more common questions about Medicare and Bright HealthCare.

Medicare basics

Medicare is a federal health insurance program made up of four distinct parts, Part A, Part B, Part C, and Part D.

  • Original Medicare (Part A & Part B) is health coverage offered through the federal government, while Medicare Advantage plans (Part C & Part D) are offered through private companies like Bright HealthCare. 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.
  • Learn more here
  • US citizens
  • Legal residents who have lived in the US for at least five years in a row
  • 65 years of age
  • Have certain disabilities
  • If you or your spouse (deceased or alive) paid Medicare taxes for at least ten years.

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.

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

You have a 7-month window to sign up. The best time to sign up is as soon as you’re eligible. If you do not sign up within your window, you will pay more for coverage.

  • AEP (October 15th to December 7th every year)
    • The Annual Enrollment Period (AEP) runs October 15th to December 7th. This is the period in which you can change plans or enroll in Medicare Advantage for the first time. If you decide to make a change, the new plan will become effective on January 1st of the upcoming year.
  • OEP (January 1 to March 31)
    • If you’re already enrolled in a Medicare Advantage plan, you have the opportunity to change plans once beginning January 1st through March 31st.
  • SEP (special circumstances)
    • When certain life events occur, you are allowed to make a one-time change during the year. Qualifying life events include, retirement, losing employer-covered insurance, or moving out of your plan’s service area.
  • Use our online shopping platform
  • Contact us for assistance
  • Contact a certified agent near you

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.

I’ve enrolled: How do I get set up with my new Bright HealthCare plan?

ID card

Approximately 10-14 days after enrollment

  • You can view and print out a new ID card in your Member Hub.
    • Log in to your Member Hub account
    • From the Member Hub dashboard, navigate to the “My Account” section
    • Click the “View ID Card” link
    • View or print your digital ID card
  • Log in to your Member Hub
  • Navigate to the "My Account" section on the homepage
  • Click the "Request New Member ID Card" link
  • Fill out the form with your member information
  • If you don’t receive your membership card within the next week or two, give us a call at (844) 926-4521 (TTY: 711)
  • Finding Your Member ID
    • If you are enrolled, but you haven't received your ID card yet, please contact Member Services for help finding your Member ID number.
  • We know ID cards can look a little intimidating. Here’s a short list of some of the lines you may see on yours and what they mean.
    • Member ID - Here’s your unique Member ID – you’ll need it to get started in the Member Hub.
    • Plan Effective Date – This is when you can start using your health plan.
    • Primary Care Physician - Your PCP is your first line of support for when you need care
    • Pharmacy benefits –basic information about what you’ll pay for prescriptions.
    • RxBIN - Banking identification number: indicates which company will reimburse the pharmacy for the cost of the prescription
    • RxPCN - Processor control number: an identifier used to route pharmacy reimbursements
    • RxGRP – Prescription group
    • Member Services – we’re here to help. Call us any time you have questions about your coverage.

2022 Welcome Package

You should receive your welcome package in the mail 7-10 days after your ID Card.

You will receive a Welcome letter, resource guide, 24-hr telehealth services magnet, and Medicare Coordination of Benefits (COB) and Health Risk Assessment form.

Member Hub

  • Register or log in at Member Hub.
    • You'll need to have your Member ID. (located on the front of your Member ID card.)
    • Names must be entered EXACTLY as it was entered on enrollment application
    • Need help? Call Member Services for assistance
  • Get digital copies of your Bright HealthCare Member ID card
  • Access your benefit information and important plan documents
  • Search the drug formulary
  • View claims status
  • Check out our helpful Member Hub resource page for more information about what you can do in the Member Hub.

What’s next: Get to know your plan

  • $0 PCP Visits
  • Hospital stay coverage
  • Preventive care
  • Prescription drug coverage
  • $0 for commonly prescribed medications
  • Comprehensive dental, hearing and vision coverage
  • Telehealth services  

*Benefits may vary by plan. .

  • Supplemental benefits vary by plan. Your plan may include any of the below extra benefits. Please check your summary of benefits in the Member Hub to view your specific plan benefits. .
    • OTC allowance or Health Dollars Visa Card*
    • Free gym membership
    • Acupuncture and Chiropractic*
    • Healthy Food Allowance*
    • Made-for-Me meals*
    • Personal Emergency Response
    • No-cost rides* *Benefits vary by plan.

The amount you pay for covered healthcare services (other than your included, no-cost benefits) before your plan starts to pay

The highest amount you’ll pay for covered services in a plan year—after you spend this amount on deductibles, copayments, and coinsurance for in-network care and services, your health plan pays 100% of the costs of covered benefits.

A monthly fee you may pay when you enroll in a plan. Not all plans have a premium.

A fee added to your monthly premium if you don’t join when you’re first eligible; applies to Part B or Part D only.

  • After you pay your deductible, a copay is a fixed dollar amount you pay for the cost of a health-related service (like a provider visit). Your health plan pays the rest.
  • After you pay your deductible, coinsurance is the percent you pay for the cost of a fee or service. Your health plan pays the rest.

View your detailed coverage information in the .

How do I get Care? Get the care you need

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.

The key to making the most of your Bright HealthCare plan is by knowing and staying within your network. Your network is the group of doctors and facilities we partner with to provide you with the personalized, quality care you deserve. Choosing to visit an in-network provider and/or facility will ensure you always get the most for your money. Learn more

Use our online provider search tool to find out.

Use our online provider search tool. Follow the on-screen prompts to choose the best provider for your needs. If you prefer, you can also give us a call.

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.

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.

Use our online provider search tool. You’ll also find a full list of in-network specialists – like endocrinologists, urologists, orthopedists, cardiologists and many others. You don’t need a referral from your PCP to see an in-network specialist.

How to get your annual wellness exam, preventive care and screenings, improving bladder control, ways to reduce risk of falling, exercises to improve on physical activity

  • Primary Care Provider (PCP): Your PCP should always be your first line of support as they will get to know your health history and can help you stay in-network. Your PCP is a great choice for:
    • Colds and other non-serious illness
    • Preventive care
    • Bronchitis
    • Minor injuries
  • Urgent Care: Visits to urgent care facilities can be a helpful alternative to PCP and telehealth visits at the right time. Urgent care is great for:
    • Needs that occur outside your PCP’s office hours
    • Minor fractures
    • Fever
    • Severe headache
    • Cuts that may require stitches
  • Emergency Care: Save visits to the emergency room for true emergencies. You will save money, and help ensure the ER staff is available to treat patients with things like:
    • Chest pain
    • Trouble breathing
    • Head trauma
    • Severe injury
  • Telehealth: COVID-19 changed life as we know it, and telehealth emerged as a major way of getting and giving care. These virtual visits allow greater flexibility and safety, and are a smart choice for:
    • Times you need to stay home
    • Times when your PCP isn’t available
    • Minor illness
    • Mental health
    • Prescription refills
  • We’re pleased to offer you a variety of telemedicine services – both locally through your Bright HealthCare providers and nationally through Doctor On Demand. Learn more here
  • 24-Hour Nurse Hotline: Call 888-687-7321 (TTY 711) any time of the day or night, 7 days a week. Our licensed nursing professionals are ready to offer helpful, timely advice about your health concerns and conditions. They can also provide insights and other information based on the symptoms you present and let you know if you should seek urgent care or emergency room services.

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.

Pharmacy & Prescription Coverage

Use our online pharmacy search tool to find a pharmacy near you.

Formulary is the formal name for the list of medications covered by your Bright HealthCare plan. It is sometimes called a “Drug List.” Find your formulary and learn how to read it here.

Talk to your doctor or pharmacist about: 100-day fills, lower tier options, generics, and mail-order. Want to learn more? Tips & tricks for saving big

Claims

Use your Member Hub account to find out more. Click here to access: Member Hub

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Website Last Updated: Oct 15 2021

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