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Medicare Frequently Asked Questions

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General FAQs | Behavioral Health | Coverage | Emergency and Coverage Away From Home | Medicare Advantage Plans | Prescription Drug Benefits | Seeing a Provider | Understanding Insurance | Terms

General FAQs

  • Where are MVP Medicare Advantage plans offered?

    MVP Health Care offers health insurance options to Medicare-eligible individuals in New York and Vermont. Not all plan types are offered in all states or counties. See our service area maps below for details.


  • Service Area Maps for Individual Plans


  • Service Area Maps for Employer-based Plans


  • What do I need to know about my MVP Member ID card?

    Within 14 days of your enrollment date, we will mail you your MVP Member identification (ID) card. Your MVP Member ID card is the key to your coverage, so make sure to keep it in a safe place. You will need to present it for services and to reference information such as your MVP Member ID number.

    Your MVP Member ID card shows your plan name, member ID number, pharmacy information, and basic costs. On the back, you’ll find important contact information.

    Your MVP Health Care Member ID card looks like this:

    MVP ID Card


  • Who accepts MVP Medicare Advantage health insurance?

    MVP is accepted by more than 23,000 doctors and hospitals throughout New York, Vermont, and in surrounding areas. MVP’s Medicare Advantage plans also include benefits to see Medicare providers who do not contract with us. Our Find a Doctor Tool can help you find the right doctor for you.


Behavioral Health

  • What is behavioral health?

    Behavioral health refers to services related to mental health and substance use. There are several types of specialists that work in these fields.

    Mental health providers include psychiatrists, psychologists, social workers, psychiatric nurse practitioners, and licensed mental health counselors.

    Substance use disorder providers includes addictionologists and alcohol and substance use counselors.


  • How can I find a behavioral health provider?

    Use our Find a Doctor tool to search for mental health or substance use disorder providers. To ensure your results include only in-network Behavioral Health providers, use the Doctors by Specialty or Places by Type search options. You can also call us at 1-888-687-6277 for help finding a behavioral health provider that participates with your plan.


Coverage

  • What preventive health services are covered in full as part of my plan?

    Dozens of preventive services and screenings to keep you healthy are covered in full, including an Annual Wellness Visit, flu shots, diabetes screening, and mammograms. Please look at your health plan materials for more information and learn more about preventive care recommendations.


  • Which services require prior authorization?

    The list of services requiring prior authorization can be found in Chapter 4, Section 2.1 of your Evidence of Coverage.

    If you are a current MVP Medicare Advantage Individual plan member, you can view plan documents here. If your MVP Medicare Advantage plan is offered through a former employer or union group, you can view your plan documents by signing in to your MVP online account.


  • What is an Explanation of Benefits (EOB)?

    An Explanation of Benefits, or EOB, is a document to keep you informed of the health care or prescription drug claims that have been submitted on your behalf. It shows what your health plan has paid to the provider, what the health plan has reimbursed to you (if applicable), any financial responsibility you may have for services provided, and any services that were not paid for by your health plan (if applicable). You will receive an EOB after MVP receives and processes a claim for health care service or filled prescription.

    EOBs can be confusing. They are often mistaken for bills (though they are not bills) and may have terms or items that are unfamiliar. For help understanding an explanation of benefits, read our helpful guide How to Read Your Explanation of Benefits (PDF)


  • What if I need a little extra help managing a medical condition?

    MVP offers free health and condition management programs that can help you better understand and treat a variety of medical conditions, such as asthma, diabetes, depression, heart disease, low back pain, and more. Learn more about our programs and contact us to see if you qualify.


Emergency and Coverage Away From Home

  • Am I covered by MVP when I am away from home?

    MVP Medicare Advantage plan members are covered for worldwide emergency room and urgently needed care. If you have a medical emergency while you are outside the service area, you should seek care from the nearest doctor or hospital emergency room. Please let MVP know about the emergency within 48 hours, or as soon as physically possible.

    MVP reserves the right to retrospectively determine if the visit is of an emergency nature. That means MVP can look at information from your emergency room visit after you are treated and let you know that your care will not be covered as emergency care.

    Please view your plan materials for details about your emergency and non-emergency coverage, including co-pays or co-insurance.


  • If I need care, but it's not an emergency, what should I do?

    If you think you need immediate life-saving care, you should go to the emergency room. But for non-emergency medical help, you often have less expensive, more convenient options:

    • Call your doctor — Many practices offer urgent appointments and can get you in quickly. If you don’t have a regular doctor, use our Find a Doctor tool to locate one in your area.
    • Try an urgent care center — If your doctor is not available, consider an urgent care center for sore throats, headaches, sprains or strains, minor cuts or burns, the flu, and more. Costs are usually lower, and wait times are often shorter than in the emergency room. Check our Find a Doctor tool for a list of in-network urgent care centers near you.
    • Get help from a Registered Nurse for free — 24 hours a day, 7 days a week. Call the MVP Customer Care Center phone number on the back of your MVP Member ID card, or sign in to your MVP member account and use our secure online form to get a response from a nurse within 24 hours.
    • myVisitNow® — Eligible MVP members have access to “face-to-face” online video visits with urgent care doctors, within minutes, for non-emergency situations. Members can register at myvisitnow.com.


Medicare Advantage Plans

  • What kind of Medicare Advantage plans does MVP offer?

    MVP offers a variety of Medicare Advantage plans. Most plans provide doctor, hospital, and prescription drug coverage all in one plan for one monthly cost. They also provide worldwide emergency and urgent care coverage, plus coverage for medical services from Medicare providers anywhere in the U.S. who do not contract with MVP for non-emergency care.

    MVP also offers a Medical Savings Account (MSA) plan. An MSA is a high-deductible Medicare Advantage plan that is like Health Savings Accounts (HSAs) available outside of Medicare.


  • Where can I learn more about different MVP Medicare Advantage plans and their costs?

    If you are a current MVP Medicare Advantage Individual plan member, you can view plan details here. Or for help over the phone, contact the MVP Medicare Customer Care Center.

    If your MVP Medicare Advantage plan is offered through a former employer or union group, you can view coverage details or contact the MVP Medicare Customer Care Center.

    If you are shopping for Medicare plan coverage, you can compare MVP Medicare plans online. If you prefer to speak with someone, call an MVP Medicare Advisor at 1-800-324-3899, Monday—Friday from 8 am to 6 pm Eastern Time. From October 1—March 31, representatives are also available on Saturdays from 8 am to 12 pm. (TTY: 1-800-662-1220)


  • How do I know which Medicare plan is best for me?

    Everyone’s situation is different so it’s important to compare plans and their total costs (including co-pays, prescriptions, etc.), not just premiums. We recommend contacting an MVP Medicare Advisor to learn more.


  • What can I expect to pay for an MVP Medicare Plan?

    MVP Medicare Advantage plans offer a variety of affordable premiums. But it’s important to look at your total costs, which include deductibles, co-pays, and co-insurance. You can compare our plans online to see which plan fits your needs and your budget.


Prescription Drug Benefits

  • Are my prescriptions covered by MVP?

    If you have prescription drug coverage with MVP, you are covered for all prescriptions on your plan’s approved list of medications. In cases where we do not cover a certain drug, we usually cover an alternative drug that does the same thing but may cost less. To find out if a specific drug is covered, review the MVP Medicare Part D Formulary. See below to learn more about MVP’s Formulary.

    The medication you need may require prior authorization or be subject to step therapy or quantity limits. This information can also be found on the Formulary. You may have a co-pay, co-insurance, or deductible to pay out of your pocket for prescriptions. Please look at your health plan materials to learn more about the cost-sharing responsibility for your plan.


  • What is MVP’s Formulary?

    The Formulary is an extensive list of drugs, both generic and brand name, which are covered by MVP for plans that offer prescription drug coverage. Each formulary is a comprehensive guide developed based on sound clinical evidence and reflecting current treatment guidelines and community practice standards.


  • What is a generic drug?

    A generic drug is a copy of a brand name drug with the same active ingredients, dosage form, safety, strength, quality, and intended use. For example, ibuprofen is a generic copy of both Motrin® and Advil®.

    Generic drugs are approved by the Food and Drug Administration (FDA) and are typically sold at a lower cost.


  • What if my physician does not prescribe a generic drug?

    While the use of generic drugs is encouraged to help you save money, you are not required to use one. You will pay more for brand name drugs when there is a generic equivalent available. Generally, generic drugs may be covered at your lowest tier co-payment. Brand name drugs that have a generic equivalent may be covered at your highest tier co-payment or may not be covered.


  • Who is CVS Caremark?

    CVS Caremark is the Pharmacy Benefits Manager and mail order vendor for MVP’s Medicare Advantage plans with prescription drug coverage. This means they process your prescription drug claims. You do not need to go to a CVS/pharmacy for your prescriptions—you can fill your prescriptions at any pharmacy that contracts with MVP, including all major pharmacy chains.

    If you have questions about your prescription drug coverage, CVS Caremark Customer Care is available 24 hours a day, seven days a week at 1-866-494-8829 (TTY: 711).


  • Can I order prescriptions through the mail?

    If your plan includes Part D prescription drug coverage, many medications that are taken regularly are available by mail order through CVS Caremark®, MVP’s contracted Pharmacy Benefit Manager (PBM) and mail order pharmacy vendor.

    Using the mail-order pharmacy lets you buy certain maintenance drugs in larger quantities and save trips to the pharmacy. When using the mail-order pharmacy, you will receive a 90-day supply of medication for the cost of two co-pays* rather than three. Refer to the MVP Medicare Part D Formulary to find which medications are available through your mail order benefit.

    * WellSelect and GoldSecure members pay 100% of the cost for drugs in Tiers 3-5 until their yearly deductible is met.


  • Are there any other requirements for prescription drugs?

    For certain prescription drugs, MVP Health Care has additional requirements or limits for coverage. These requirements were developed by a team of doctors and pharmacists, and they help us provide quality coverage to our members by helping to control drug plan costs and ensuring that members use drugs in the most effective ways. Certain drugs may require prior authorization, have a formulary exception, require step therapy, or be subject to quantity limits. If you have questions about other drug requirements, contact MVP using the phone number listed on the back of your MVP Member ID card.


  • How do I obtain specialty drugs?

    Some prescription drugs must be obtained through CVS Specialty Pharmacy. CVS Specialty Pharmacy provides high-touch, high-cost drugs for rare and complex medical conditions and delivers them to your doorstep. To find out if a drug you have been prescribed is a specialty medication, please review the Medicare Part D Formulary.


  • How can I save money on my prescription drugs?

    The best way to manage your prescription drug costs is to become a savvy consumer. Here are some tips to help you save money on prescription drugs.


  • What are Part B drugs?

    Part B drugs are drugs that must be administered by a doctor, as well as certain medical equipment, such as diabetic test strips and lancets. Part B drugs are covered under the medical portion of your plan benefits and are not listed in the Medicare Part D Formulary.

    Examples of Part B drugs and supplies include:

    • Diabetic testing supplies (see “How are diabetic supplies covered?” below), including testing meters, lancets, and OneTouch® brand test strips. You are allowed 200 test strips for 30 days and 600 test strips for 90 days.
    • Inhalation spacers used with inhalers, such as Aerochamber and Optichamber (1 spacer per 365 days).
    • Oral Chemotherapy Agents, such as Xeloda (capecitabine) and Temodar (temozolomide).


  • How are diabetic supplies covered?

    Individual Plan Members pay a 10% co-insurance for OneTouch brand test strips and blood glucose monitors.

    Employer-Based Plan Members are eligible for OneTouch, Freestyle, and Precision brand test strips and blood glucose monitors. Please refer to your Evidence of Coverage (EOC) for cost-sharing.

    All other test strips and monitors from non-preferred manufacturers are excluded from coverage. You can ask MVP to cover an excluded monitor or test strip from a non-preferred manufacturer. All requests should include a statement from your prescriber or doctor supporting the request.


  • How are vaccines covered?

    Most vaccines are covered under your Part D pharmacy benefit, which also includes the cost of administering vaccines. Some vaccines are covered as a preventive service under your Part B medical benefits, such as pneumococcal, rabies, and flu vaccines.

    Vaccines can be given at a pharmacy or by your doctor. Many are available at no cost, though an office visit co-pay may apply when vaccines are given at your doctor’s office.

    Always ask your doctor to process your Part D vaccine claims through a service called TransactRx. If your doctor does not process through TransactRx, you will have to pay out-of-pocket for your vaccine and request reimbursement for those costs.

    Ask your doctor if he or she will charge more than MVP’s allowed amount for the vaccine. If he or she does, you may be responsible for any additional costs.

    Find out if any local pharmacies administer the vaccine you need, as this is can be more cost-effective and simpler for many members.


  • Can I fill prescriptions when I’m away from home?

    You should try to refill any prescriptions before going out of town. Your doctor may need to send the pharmacy a new prescription for an extended supply.

    If you’re traveling in the U.S. for longer than your current prescription will last, ask your doctor for a new prescription to fill at your travel destination or take your prescription bottle (with the label intact) to the pharmacy and ask if they will transfer a refill for you. You can go to any national chain that is in MVP’s national pharmacy network, including CVS, Rite Aid, Walgreens, or Walmart. Remember to show your MVP Member ID card at the pharmacy.

    According to Medicare rules, prescriptions filled outside of the U.S. are not covered.


  • What are MVP’s Opioid Prescription Safety Measures?

    As of January 1, 2019, the federal Medicare program has introduced new safety policies for opioid prescriptions. Opioids are a class of drug prescribed and used to help treat pain. If you are filling an opiate prescription for the first time or do not regularly take opioids, your prescription will be limited to a seven-day supply. If your doctor prescribes more than a seven-day supply, you or your doctor can ask for a coverage determination and ask MVP to cover more medication. Members undergoing certain medical treatments are excluded from this seven-day limit (such as members prescribed opiates for pain during cancer treatment, enrolled in hospice or palliative care, or who are residents of a long-term care facility).

    All opiate medications must still be listed on the MVP Heath Care Medicare Part D Formulary to be covered. Medications that require prior authorization will still need approval from MVP before the prescription can be filled. The pharmacist may contact your doctor for more information before filling your prescription.


Seeing a Provider

  • How do I know which health care providers are in the MVP network?

    MVP offers a comprehensive network of contracted hospitals, doctors, and other health care professionals across New York and Vermont, and into neighboring areas.

    You can find providers in your network by using the Find a Doctor search. Enter your MVP Member ID number and location to find doctors in MVP’s network. If you’re not an MVP member and don’t have an MVP Member ID number, you can search by location and plan type to find providers who participate with our Medicare Advantage plans.


  • How much will I pay to see providers in the MVP network?

    Members will pay a co-payment or co-insurance for medical services from MVP network providers. Review your health plan materials for more information about your network, benefits, out-of-pocket costs, and other important details.


  • Can I go to any doctor or hospital I want, or must I use MVP-participating doctors and hospitals?

    MVP has made arrangements with many physicians, hospitals, laboratories, and other health care organizations to provide services to our members. When you use a health care provider who is part of the MVP network (in-network), you will pay your applicable co-payment or co-insurance.

    Use our Find a Doctor search tool to find participating doctors, hospitals, labs, and pharmacies near you.

    Most MVP Medicare Advantage plans include coverage for the medical care you get from Medicare providers who are not part of the MVP network. These are called “out-of-network benefits.” If your health plan does not include out-of-network benefits, the MVP Medical Director may make arrangements for you to receive care with non-participating physicians and/or hospitals when it is medically necessary. In such cases, prior written approval must be obtained.

    Also, MVP will cover emergency room and urgently needed care for members at non-participating hospitals or health care facilities. You must seek any necessary follow-up care from MVP-participating providers.

    For coverage details, please look at your health plan materials.


  • How do I access an online doctor visit?

    For more information on myVisitNow®, click here.

    For more information on myERnow, click here.


  • Can I change my Primary Care Physician (PCP)?

    Yes. If you chose a PCP as a required part of your health plan coverage, you may change your PCP at any time. Simply sign in to your account to change your PCP or call the MVP Customer Care Center at the phone number on the back of your MVP Member ID card.


  • Do I have to contact my Primary Care Physician (PCP) and request a referral before I see a specialist?

    MVP plans do not require referrals for specialists. However, it is a good idea to talk with your primary care physician about any medical concern you have. He or she may be able to offer treatment or recommend a specialist who can help.


  • How can I enhance communications with my providers?

    Written or verbal communication between Primary Care Physicians (PCPs), specialists, and other practitioners helps provide effective follow-up care and improved patient safety.

    Here are some tips that you can follow to help facilitate this process:

    • Always keep the name, phone number, and address of your PCP handy. Offer to provide this information to any health care professional you see, even if they don’t ask for it.
    • Ask your health care professionals to send pertinent information to your PCP.
    • Keep copies of your medication list, recent physical exam, and important test results and bring them to each office visit in case the practitioner has not obtained them from your PCP.


  • How do I access a provider who is not part of MVP’s network?

    Most MVP Medicare Advantage plans include out-of-network coverage for services from providers who are not part of MVP’s network. However, you must confirm that the provider accepts Medicare. If they do not, you will be responsible for the entire cost of services.

    You can see Medicare providers anywhere in the U.S. for routine care, such as allergy shots, physical therapy, or maintenance lab work. Your costs will vary by your plan type. Please look at your health plan materials for more information.


Understanding Insurance

  • How can I get more information or answers to questions about my MVP health plan?

    Our Customer Care Center is available to answer your questions and help you better understand your MVP health plan. Visit the Contact Us page of our website or call the phone number on the back of your MVP Member ID card. You can also:

    • Send us an email. To make sure that your personal health information is safe, please log in to your online account and use our secure email form to email the Customer Care Center.
    • Try our Live Chat feature.


  • If I get a bill for medical services that I don’t understand, what should I do?

    Please call the Customer Care Center using the phone number on the back of your MVP Member ID card if you have questions about a bill.


Terms

  • What is Medicare?

    Medicare is the federal health insurance program for people who are 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD).


  • What is Original Medicare?

    Original Medicare refers to Medicare Part A and Part B. It is referred to as “original” Medicare because these were the only two parts of Medicare when the program started.


  • What is a Medicare Advantage plan?

    A Medicare Advantage health plan (or Part C plan) is an alternative to Medicare Parts A and B. Medicare Advantage plans typically cover what Part A and Part B cover, and include other benefits, such as Part D prescription drug coverage (see below), dental and vision benefits, and more. MVP’s Medicare Advantage plans provide doctor, hospital, and prescription drug coverage all in one plan for one monthly cost. Learn more about our Medicare Plans.


  • What is Medicare Part D?

    Medicare Part D is prescription drug coverage. Part D drug coverage is offered by private companies and includes drugs that are federally approved for Medicare beneficiaries. Most of MVP’s Medicare Advantage plans include Part D coverage, providing one convenient monthly premium for both medical and prescription coverage.


  • Other Terms

    For a comprehensive list of health care terms, visit MVP’s Glossary of Health Insurance, Health Care, and Health plan terms.


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