Piedmont Medicare Advantage (PPO)
CLICK HERE for list of "Special Events"
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 Medicare Advantage is available to Medicare eligible beneficiaries located in the counties of Amherst, Appomattox, Campbell, Charlotte, Halifax, Pittsylvania, and Prince Edward as well as 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.
Medicare beneficiaries may enroll in Piedmont’s Medicare Advantage Plans through the CMS Medicare Online Enrollment Center located at http://www.medicare.gov/default.aspx.
Members may enroll in the plan only during specific times of the year. Contact Piedmont Medicare Advantage for more information.
Benefits, formulary, pharmacy network, premium and/or co-payments/co-insurance may change on January 1, 2012.
A Coordinated Care plan with a Medicare Advantage Contract
Piedmont’s Medicare Advantage Plans:
2012 Plans and Benefits
Piedmont’s Medicare Advantage Plans include:
- Prescription drug coverage
- Comprehensive formulary with a wide selection of participating pharmacies
- Benefits of Original Medicare with lower cost-sharing
- Zero cost-sharing for preventive care
- Low monthly premiums
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 am to 8 pm, seven days a week from October 15 through February 14. From February 15 until the next Annual Enrollment Period, Customer Service is available from 8 am to 8 pm, Monday through Friday. Our local office is open for walk-in customer assistance from 8:30 am to 5 pm, 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
Both 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.
Medicare Links:
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 (1800-633-4227). 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
2012 LIS Premium Summary Table
Other Information:
- Part D Prescription Drug Coverage
- Finding a participating provider or pharmacy 2012
- Addendum to Provider/Pharmacy Directory (updated 02/14/2012)
- Finding a presciption drug on our formulary 2012
- Grievance, coverage determination, and appeals process
- Privacy notice
- Prior Authorization Criteria
- Step Therapy Criteria
Forms:
- Individual Enrollment Form 2012 .
- Short Enrollment Form 2012 .
- Medical Paper Claim Form
- Prescription Drug Paper Claim Form
- Prescription Drug Mail Order Form
- Medicare Prescription Drug Determination Request Form
- Medicare Redetermination Request Form
- Medicare Complaint Form
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_WebRev2012 CMS Approved 12302011
Last updated 02/21/2012
