Preferred Gold HMO-POS — Medicare plus more!

There’s no one just like you. So it makes sense that when you shop for a health plan, you look for an insurance company that offers variety and choice in finding the coverage that will best fit your individual needs.

Our plans are designed to be easy to use and simple to understand. And as an MVP Medicare plan member you gain much more than with Original Medicare coverage. Our plans are loaded with these great extras:

• $0 copay for select generic Part D prescription drugs and select vaccines. (Preferred Gold with Part D only).
• Plans with NO medical or prescription deductibles.
• No specialist referrals needed.
• Freedom to see MVP network doctors, or see doctors of your choice outside of our network, for an additional cost.
• Up to $300 for preventative dental services (Preferred Gold with Part D only).
• A dedicated service team.

NOTE: If your coverage is through an employer sponsored plan, all benefits may not apply.

What you get with Preferred Gold HMO-POS:

* Any unused portion of these benefits cannot carry over from one calendar year to the next.

Part D coverage
MVP offers Medicare prescription drug coverage (Part D) with our Preferred Gold plan.  If you wish to join our Preferred Gold plan and you also want prescription drug overage, you must select Part D prescription drug coverage from MVP Health Care.

MVP’s coverage for medically necessary Medicare Part D approved drugs includes:

• Tier 1 – Preferred Generic Drugs
• Tier 2 – Preferred Brand Name Drugs
• Tier 3 – Non-preferred Brand Name and Non-preferred Generic Drugs
• Tier 4 – Specialty Drugs
• Tier 5 – No Cost Generic Drugs

Part D drugs excluded from our formulary must go through an exception process in order to be covered. If they are approved, they will be covered in Tier 3.

Once your total drug expenses in 2012 reach $2,930, you will pay 86% for generic drugs, 50% for Medicare-contracted brands, 100% for non-Medicare contracted brands and $0 for Tier 5 drugs. When you have paid $4,700 out of pocket in 2012, your cost for prescriptions is reduced to the greater of 5% or $2.60 for generics and $6.50 for brand-name drugs in Tiers 1-4. Tier 5 drugs will be $0.. 

If you are taking a Tier 5 medication, it will be $0 in the initial coverage phase, coverage gap or “donut hole” and catastrophic coverage phase.

Mail order - a 90-day supply through Medco mail order is: Tier 1 - $16 / Tier 2 - $70 / Tier 3 - $180 / Tier 4 - 33% / Tier 5 - $0

Note: Not all Part D drugs are available through the mail. Costs for Part B drugs and supplies are 20%. Drugs purchased outside the U.S. are not Medicare approved and are not covered.

To enroll, call a licensed MVP Medicare Products Advisor
You can ask questions or reserve a seat at an informational meeting:
Monday – Friday, 8 am to 5 pm Eastern Time
1-888-280-6205
TTY users may call 1-800-662-1220
From October 15 – February 14, call seven days a week from 8 am to 8 pm

Or

Call MVP’s Medicare Customer Care Center
Representatives are available to serve you:
Monday – Friday, 8 am to 8 pm and Saturday, 8 am – 4 pm Eastern Time
1-800-665-7924
TTY users may call 1-800-662-1220
From October 15 – February 14, call seven days a week from 8 am to 8 pm

MVP Health Plan, Inc. is a Federally-qualified not-for-profit HMO-POS with a Medicare contract.  Plan availability and premium rates may vary by county.

The benefit information provided herein is a brief summary, not a comprehensive description of benefits.  For more information, contact MVP. You must have both Part A and Part B to enroll, and continue to pay your Part B premium. You may be able to get Extra Help to pay for your prescription drug premiums and costs. To see if you qualify for extra help, call 1-800-MEDICARE (1-800-633-4227). TTY users may 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 and 7 pm, Monday through Friday. TTY users may call 1-800-325-0778; or your State Medicaid Office.

HMO-POS members may see doctors within and outside of the MVP network. However, with the exception of emergencies or urgent care, it will cost more to get care from out-of-network providers.  You must use network pharmacies to access your prescription drug benefit, except under non-routine circumstances, and quantity limitations and restrictions may apply. Benefits, formulary, pharmacy network, premium and/or copayments/coinsurance may change on January 1, 2013. This document is available in other formats or languages. Call MVP at the phone numbers above for more information.

Last updated: January 12, 2012
Y0051_1281 Pending CMS Approval