Piedmont Medicare Advantage (PPO)
In our continuous effort to provide local coverage and service to as much of the community in which we serve, as we can, Piedmont Community HealthCare is pleased to announce a new product offering for the local community - Piedmont Medicare Advantage (PPO).
Piedmont Medicare Advantage will be available for 2011 to Medicare eligible beneficiaries located in the counties of Amherst, Appomattox, Campbell, Charlotte, Halifax, and Prince Edward and in the cities of Bedford and Lynchburg.
Portions of Bedford County are also included in the service area (specifically zip codes 24095, 24104, 24121, 24122, 24174, 24502, 24503, 24523, 24526, 24536, 24550, 24551, 24556, 24570, and 24571).
Medicare beneficiaries may enroll in Piedmont Select Medicare Option One (PPO) and Piedmont Select Medicare Option Two (PPO) through the CMS Medicare Online Enrollment Center located at http://www.medicare.gov. CLICK HERE for a link to http://medicare.gov.
Piedmont Medicare Advantage is a Coordinated Care plan with a Medicare Advantage Prescription Drug contract that offers two plan options for 2011. For a plan description of each of the products offered, click on the option below:
Piedmont Select Medicare Option One (PPO)
Piedmont Select Medicare Option One offers coverage for Medicare Part C that is just as good and/or better than the coverage for Medicare Parts A and B. This plan also includes coverage for Part D prescription drug. You must continue to pay your Part B premiums in addition to the monthly premium of $57.00 for this plan. Most people will pay the standard monthly Part B premium; however, some people will pay higher Part B and Part D premiums because of their yearly income. For more information call Medicare at 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048. You may also call Social Security at 1-800-772-1213. TTY users should call 1-800-325-0778.
Piedmont Select Medicare Option Two (PPO)Piedmont Select Medicare Option Two offers coverage for Medicare Part C that is just as good and/or better than the coverage for Medicare Parts A and B. This plan also includes coverage for Part D prescription drug. You must continue to pay your Part B premiums in addition to the monthly premium of $27.00 for this plan. Most people will pay the standard monthly Part B premium; however, some people will pay higher Part B and Part D premiums because of their yearly income. For more information call Medicare at 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048. You may also call Social Security at 1-800-772-1213. TTY users should call 1-800-325-0778.
Both of these plans utilize the same extensive Piedmont network our members have come to know and appreciate in the community that includes almost all local physicians and hospitals, and of course, Centra. Our plans will cover services from either in-network or out-of-network providers, as long as the services are covered benefits and medically necessary.
However, if out-of-network providers are used, your share of costs for your services may be higher and that provider must participate in Medicare. Our Provider/Pharmacy Directory along with our Addendum to the Provider/Pharmacy Directory (see below) lists providers that participate in our network.
Potential members can access additional nformation on each plan's benefits including the benefits listed below by clicking on the following links for each plan:
Piedmont Select Medicare Option One (PPO)
- Evidence of Coverage
- Summary of Benefits
- Provider/Pharmacy Directory
+ Addendum to Provider/Pharmacy Directory (04/08/2011)
+ Addendum to Provider/Pharmacy Directory (05/25/2011) - Formulary "Drug List"
Piedmont Select Medicare Option Two (PPO)
- Evidence of Coverage
- Summary of Benefits
- Provider/Pharmacy Directory
+ Addendum to Provider/Pharmacy Directory (04/08/2011)
+ Addendum to Provider/Pharmacy Directory (05/25/2011) - Formulary "Drug List"
Potential members can also get additional information or plan benefits by contacting Piedmont Medicare Advantage's Customer Service Department.
With Piedmont Select Medicare Option One and Piedmont Select Medicare Option Two you also have:
- Prescription drug coverage;
- Comprehensive formulary with a wide selection of participating pharmacies;
- Benefits of Original Medicare with lower cost sharing;
- Emergency coverage when you travel;
- Zero cost-sharing for preventive care; and
- Low monthly premiums.
Medicare’s Extra Help Program
The Social Security Administration and the Centers for Medicare & Medicaid Services are working together to get you Extra Help with your Medicare prescription drug plan costs. If you have limited resources and income, you may qualify for Extra Help with the costs—monthly premiums, annual deductibles, and prescription co-payments—related to a Medicare prescription drug plan.
To find out if you qualify, Social Security will need to know the value of your savings, investments, and real estate (other than your home), and your income. If you are married and living with your spouse, we will need information about both of you. By filing an Application for Extra Help with Medicare Prescription Drug Plan Costs (Form SSA-1020), Social Security will determine if you are eligible for the Extra Help.
Most of the questions on the application deal with resources and income. Social Security will not ask for documentation initially to support the information you provide, but will match your information with data available from other Federal agencies.
What is the resource limit for Extra Help?
To qualify for Extra Help, your total resources must be limited to $12,510 for an individual ($25,010 for a married couple living together). Resources include the value of the things you own. Some examples are:
- Real estate (other than your primary residence);
- Bank accounts, including checking, savings and certificates of deposit;
- Stocks;
- Bonds, including U.S. Savings Bonds;
- Mutual funds;
- Individual Retirement Accounts (IRAs); or
- Cash at home or anywhere else.
What does not count as a resource for Extra Help?
Social Security will not count:
- Your primary residence;
- Your personal possessions;
- Your vehicle(s);
- Resources you could not easily convert to cash, such as jewelry or home furnishings;
- Property you need for self-support, such as rental property or land you use to grow produce for home consumption;
- Non-business property essential to your self-support;
- Burial spaces;
- Life insurance policies;
- Interest earned on money you plan to use for burial expenses; and
- Certain other money you are holding is not counted for nine months, such as:
- Retroactive Social Security or Supplemental Security Income (SSI) payments;
- Housing assistance;
- Tax advances and refunds related to earned income tax credits and child tax credits;
- Compensation you receive as a crime victim; and
- Relocation assistance from a state or local government.
You should contact Social Security for infomation about other exclusions.
1-800-MEDICARE (1-800-633-4227). TTY users should call
1-877-486-2048, 24 hours a day, 7 days a week;
The Social Security Office at 1-800-772-1213, between 7 am to 7 pm,
Monday through Friday. TTY users should call 1-800-325-0778; or
Your State Medicaid Office at 1-804-786-7933.
TTY users should call 1-800-343-0634.
For more information on Extra Help or Low Income Subsidy premiums, CLICK HERE for a link to the CMS Best Available Evidence (BAE) Policy.
For your convenience we have provided specific information and reference materials on the following topics:
- Part D Prescription Drug Coverage
- Finding a participating provider
- Finding a participating pharmacy
- Finding your prescription drug on our formulary
- Information on grievance, coverage determinations, and appeals processes
- Privacy notice
Forms you may need:
- Individual Enrollment Form
- Short Enrollment Form
- Medical Paper Claim Form
- Prescription Drug Paper Claim Form
- Prescription Drug Mail Order Form
To get the most up-to-date information call our Medicare Customer Service Department at one of the telephone numbers listed below, from 8:00 AM to 8:00 PM, seven days a week from November 15 - March 1. From March 2, 2011, through the following annual enrollment period,
Customer Service will be available 8:00 AM to 8:00 PM, Monday - Friday, except for federal holidays. Our local office is open for walk-in customer assistance from 8:30 AM to 5:00 PM, Monday - Friday (except holidays), at 1937 Thomson Drive, Lynchburg, VA, 24501.
Customer Service local number: (434) 947-3671
Customer Service toll free number: (877) 210-1719
TTY users should call (877) 295-1454
The benefit information provided herein is a brief summary, but not a comprehensive description of available benefits. Additional information is available to assist you in making a decision about your coverage.
All Medicare Advantage Plans agree to stay in the program for a full year at a time. Each year, the plans decide whether to continue for another year. Even if a Medicare Advantage Plan leaves the program, you will not lose Medicare coverage. If a plan decides not to continue, 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.
Back to Piedmont Community Health Plan homepage
H1659_Web2011 CMS Approved 11182010
Last updated: 11/18/2010