MVP Gold : MVP Health Care

How to join MVP Gold

You may join MVP Gold:

When you first become eligible for Medicare benefits, which includes:
- the 3 months before your 65th birthday month
- the month in which you turn 65, and
- the 3 months after your 65th birthday month.
Due to a disability that qualifies you for Medicare.
During the annual enrollment period which runs from November 15 through March 31.
When you move into the MVP Gold service area from somewhere else and are losing your former Medicare health plan.
If you have lost your employer-sponsored Medicare health plan coverage.
If you are eligible for both Medicaid and Medicare.

Signing up for Medicare Part D drug coverage

MVP Gold also offers Medicare prescription drug coverage (Part D). If you wish to join one of our Gold plans and you also want prescription drug coverage, you must select Medicare prescription drug coverage from MVP Gold. Visit MVP Gold Rx Coverage for details on our prescription drug plan.

You may enroll during the annual election period for Part D sign-up, from Nov. 15 through Dec. 31.
If you are eligible for New York State’s EPIC (Elderly Pharmaceutical Insurance Coverage) program, you may be eligible to join Part D after December 31. To find out if you qualify, call EPIC at (800) 332-3742.
If you are eligible to receive extra help with prescriptions (called Low Income Subsidy). To find out if you qualify, call the Social Security Administration Office at (800) 772-1213. TTY users may call (800) 325-0778. Or call the New York State Health Insurance Information, Counseling and Assistance Program at (800) 333-4114.

Note: If you do not join a Medicare prescription drug plan when you first become eligible, you may have to pay a penalty if you join at a later date. The penalty can be 1% of the current premium for every month you delay enrollment for as long as you are enrolled in Part D coverage.

Once you join our Gold plan

Joining MVP Gold will automatically disenroll you out of any other Medicare managed care plan in which you may currently be a member.
We will tell Medicare that you have joined our plan. MVP Gold takes the place of Medicare. Keep your Medicare card for your records.
All of your medical care should be provided by our health care professionals in our network.
If you sign up for Medicare prescription drug coverage (Part D) with MVP Gold, you will receive your Medicare prescription drug benefit through MVP Gold. If you also have prescription drug coverage through the state’s EPIC program or a VA program, that coverage may continue as well.
Emergency and post-stabilization services (follow-up care after a hospitalization or surgery), urgent care services, and dialysis are covered when you are outside of the service area, the same as when you are at home.
If you obtain routine care from a health care professional who practices in the MVP Gold service area but is not part of MVP’s network of Medicare Advantage health care professionals, neither MVP Gold nor Medicare will be responsible for the costs. Routine care includes foreseen services or care that you may need while traveling, such as allergy shots or physical therapy that you know you will need while you’re away from home.
The cost of routine care from out-of-network health care professionals outside of MVP Gold’s service area will be covered 70% up to $3,000 annually, anywhere in the United States.

MVP will not refuse coverage based on your current health status or anticipated use of health care services unless you have end-stage renal disease. If you have end-stage renal disease, current federal law does not allow you to join MVP Gold unless you are already an MVP Health Plan, Inc. member.

Once you join our GoldAnywhere plan

Joining MVP GoldAnywhere will automatically disenroll you out of any other Medicare managed care plan in which you may currently be a member.
We will tell Medicare that you have joined our plan. MVP GoldAnywhere takes the place of Medicare. Keep your Medicare card for your records.
If you sign up for Medicare prescription drug coverage (Part D) with MVP GoldAnywhere, you will receive your Medicare prescription drug benefit through GoldAnywhere. If you also have prescription drug coverage through the state’s EPIC program or a VA program, that coverage may continue as well.
Emergency and post-stabilization services (follow-up care after a hospitalization or surgery), urgent care services, and dialysis are covered when you are traveling, the same as when you are at home.

MVP will not refuse coverage based on your current health status or anticipated use of health care services unless you have end-stage renal disease. If you have end-stage renal disease, current law does not allow you to enroll in MVP GoldAnywhere unless you already are an MVP member or have had a successful kidney transplant.

Some services require “prior authorization” by MVP regardless of whether these services are given in-network or out-of-network. Prior authorization refers to a process in which MVP works with you and your doctors to make sure you receive medically necessary, high-quality medical treatment at a reasonable cost. Some examples of services needing prior authorization include:

Admissions to transitional care units, acute rehabilitation, skilled nursing facilities
Durable medical equipment
Home care services
Implants and internal prosthetics
Medically necessary dental services
Prescription drugs

Most often, your family doctor will begin the process and request authorization whenever it is needed.

If you need or want a medical service not available within the MVP GoldAnywhere health care professional network, you may refer yourself to a doctor or service outside the network. Remember that it may cost you more to receive medical services outside of the MVP health care professional network.

Ready to join? It’s easy!

Complete, sign, and date an MVP Gold application.
Each person must complete his or her own form.
Choose MVP Gold with or without prescription drug coverage.

If you choose MVP Gold with prescription drug coverage

You may be billed directly by MVP Gold.
You may pay the monthly premium by check or money order.
You may have the monthly premium for your health plan and the prescription drug plan taken from your monthly Social Security check.

NOTE: EPIC members are not eligible for premium deductions from their Social Security check.

NOTE: 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 does not cover.

If you choose MVP Gold without prescription drug coverage

You may be billed directly by MVP Gold.
You may pay the monthly premium by check or money order.

You will be billed monthly, but you may pay quarterly if you choose.

To Join MVP Gold

Download the MVP Gold application (pdf). You can select MVP Gold with or without prescription drug coverage right on the application
Complete the MVP Gold application and be sure to sign and date the application
Include a check or money order to cover the first month’s premium for each person who is joining
Send your completed application and payment to MVP at the address on the application
If you are interested in having your premium directly withdrawn from your checking account, please print and use the MVP Gold Direct Payment Plan Automation form.

We must receive your application no later than the last working day of the month to meet Medicare’s deadline to be effective the first day of the next month. For example, if we receive your application on January 31, your coverage will begin February 1.

NOTE: Current state and federal confidentiality laws require that you complete and return an Authorization to Disclose Information (ADI) form. Unless we have an ADI form signed by you, MVP cannot disclose any information about your contract to anyone other than yourself, including your spouse and children.

If you have any questions about the MVP Gold application, please call MVP Monday through Friday, from 7:00 a.m. to 8:00 p.m. Eastern Time at:

Toll Free:
(800) 671-7504

TTY users may call:
(800) 662-1220

From Nov. 15 - March 1, representatives are also available weekends from 8:00 am to 8:00 pm at the above numbers.