Piedmont Medicare Advantage (PPO)
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In our continuous effort to provide local coverage and service to as much of the community in which we serve, Piedmont Community HealthCare is pleased to continue offering Piedmont Medicare Advantage (PPO) to our local community.
Piedmont's Medicare Advantage Plans
Piedmont's Medicare Advantage Plans offer:
| • | Low premiums including a zero premium option |
| • | No referrals required |
| • | Prescription drug coverage |
| • | Comprehensive formulary with a wide selection of participating pharmacies |
| • | Low maximum out-of-pocket costs |
| • | Benefits of Original Medicare with lower cost-sharing |
| • | Emergency coverage when you travel |
| • | Zero cost-sharing for preventive care |
| • | Vision coverage |
| • | Optional Supplemental Dental benefits |
| • | Discounts on a variety of additional services such as eyewear, hearing services, fitness centers, massage services, orthotics, and vitamins & supplements |
Potential members can also get additional information on plan benefits by contacting Piedmont Medicare Advantage’s Customer Service Department. Customer Service is available from 8:00 a.m. to 8:00 p.m., seven days a week from October 1 through February 14. From February 15 through September 30, Customer Service is available from 8:00 a.m. to 8:00 p.m., Monday through Friday. Our local office is open for walk-in customer assistance from 8:30 a.m. to 5:00 p.m., Monday - Friday, except for 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
All of the Piedmont Medicare Advantage 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; including 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 lists providers that participate in our network.
Piedmont Medicare Advantage is available to Medicare eligible beneficiaries located in the counties of Amherst, Appomattox, Campbell, Charlotte, Halifax, Pittsylvania, 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).
Individuals must have both Part A and Part B to enroll.
You must not have End Stage Renal Disease (ESRD). There are limited exceptions, such as if you develop ESRD when you are already a member of a plan that we offer, or you were a member of a different plan that was terminated.
Medicare beneficiaries may enroll in Piedmont’s Medicare Advantage Plans through the CMS Medicare Online Enrollment Center located at www.medicare.gov.
Members may enroll in the plan only during specific times of the year. Contact Piedmont Medicare Advantage for more information.
Medicare Links
Medicare Ombudsman
Medicare Official Site
Medicare's Extra Help Program
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 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 a.m. and 7 p.m., Monday through Friday. TTY users should call, 1-800-325-0778; or Your Medicaid Office.
CMS Best Available Evidence (BAE) Policy
LIS Premium Summary Table
| • | 2013 LIS Summary Table |
Other Information
Forms
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.
The benefit information provided is a brief summary, not a complete description of benefits. For more information contact the plan.
Limitations, copayments, and restrictions may apply.
Benefits, formulary, pharmacy network, premium and/or co-payments/co-insurance may change on January 1 of each year.
You must continue to pay your Medicare Part B premium.
Piedmont Community HealthCare is a Coordinated Care plan with a Medicare contract.
H1659_Web2013 Approved 10152012
Last updated 05/01/2013
