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Frequently Asked Questions
Applying For Original Medicare
If you plan to retire at 65, apply for Medicare through your local Social Security office up to 3 months before your 65th birthday, unless you're already receiving Social Security benefits. You may have to pay a late enrollment penalty if you delay signing up for Medicare more than 3 months after you turn 65.
If you're already receiving Social Security benefits, you do not need to apply for Medicare. You will automatically be enrolled. Social Security will send you a packet with your Medicare card approximately three months before you turn 65.
If you plan to continue working after age 65, if you or your spouse continue to work, and you or your spouse are covered under a group plan, take your Medicare questions to your local Social Security office or your group benefits administrator. It might not be in your best interest to sign up for Medicare Part B right now.
You may contact Social Security as soon as 3 months before your 65th birthday to request your Medicare card, and there are 3 ways to do it:
Anyone receiving Medicare is eligible for Medicare Part D and can receive this optional coverage by enrolling in a Medicare Advantage plan with Part D coverage, or a stand-alone Medicare prescription drug plan (PDP). Many Univera Healthcare Medicare health plans offer prescription drug coverage.
Original Medicare covers inpatient hospital care (Part A) and outpatient medical expenses (Part B).
In most cases, you can go to any doctor, other health care provider, hospital, or other facility that's enrolled in Medicare and is accepting new Medicare patients. With a few exceptions, most prescriptions aren't covered under Original Medicare.
Medicare charges a monthly premium for Medicare Part B (medical insurance). Most people will pay the standard premium amount, which may change from year to year. For most people, the Part B premium is deducted from their Social Security check. Medicare Part A (hospital insurance) is usually premium-free for most people. For further information see Medicare.gov web site
Medicare Advantage plans, also called Part C plans, are offered by private insurers and offer more benefits and services than Original Medicare. In addition to all services under Medicare Part A (hospital) and Medicare Part B (medical), many Medicare Advantage plans cover Medicare Part D prescription drug coverage, vision services, and health and wellness programs.
In most cases, Original Medicare does not provide dental or vision coverage. Most Univera Healthcare Medicare Advantage plans offer preventive dental and some vision services.
Medicare is a federal program that provides health insurance to people age 65 and over, people with end-stage renal disease (ESRD), and people under 65 with certain disabilities.
Medicaid is a public health care program for families and individuals with low income and resources.
Throughout the year, the Centers for Medicare & Medicaid Services sends out updates about additional covered services or changes to existing covered services. These notifications are called National Coverage Determinations (NCDs). When NCDs become available, they will be posted here to view and download.
Yes. We offer affordable Medicare Advantage and Medicare Supplement health plans. See the plans and rates available in your area.
You must meet these 4 requirements:
- You are entitled to Medicare Part A (hospital insurance) and enrolled in Part B (medical insurance).
- You reside in our Univera Healthcare service area for the plan in which you are enrolling.
- You enroll during a valid enrollment period. See details on enrollment periodsOpens a PDF.
- You do not have end-stage renal disease (ESRD). There are limited exceptions to this, such as if you are already a member of our plan (in the same region in which you wish to enroll).
No. Enrollment in an Univera Healthcare Medicare health plan requires no health exam, and there is no age limit. However, if you have end-stage renal disease (ESRD) and require dialysis, you are not eligible for one of our Medicare health plans unless you are currently a member of the Univera Healthcare region in which you wish to enroll, and were diagnosed with ESRD while a member. You may join our plan if you have had a kidney transplant and no longer require life-sustaining dialysis.
No. You do not lose Part A and Part B coverage. When you become a member of our plan, Univera Healthcare will provide your Medicare benefits to you. You must maintain your Part B Medicare enrollment in order to keep your coverage in our Medicare health plan.
Univera Healthcare offers Medicare health plans with a $0 premium option in some areas. In other areas, you might pay monthly premiums and copayments for the services you receive from Univera Healthcare. You must continue to pay your Medicare Part B premium and any other applicable Medicare premium(s).
Learn more about our Medicare Advantage plans. Browse our Medicare health plans & rates section now.
You can sign up for our Medicare health plan as soon as you’re ready to retire. Enroll online now or call us, and one of our licensed Univera Healthcare Medicare health plan sales specialists will make sure you're all set.
Yes. You can continue your Univera Healthcare membership and use the Medicare benefits you're qualified for by joining our Medicare health plan once you are eligible.
Yes, they can purchase their own Medicare health plan as long as your spouse is eligible for Medicare.
You can easily enroll online. You may also download the enrollment form, complete it, and mail it to us. Or call 1-800-671-6081 (toll free) or TTY 1-800-662-1220, 8 a.m. to 8 p.m., Monday – Friday and our licensed sales advisor will be happy to help you. From Oct. 1 – Dec. 30, advisors are also available weekends from 8:00 a.m. – 8:00 p.m. Closed Thanksgiving Day, Christmas Eve, Christmas Day, New Year’s Eve, and New Year’s Day.
Please contact Univera Healthcare at 1-800-671-6081 (toll free) or TTY 1-800-662-1220, 8 a.m. to 8 p.m., Monday – Friday. Advisors are available to help you. From Oct. 1 – Dec. 30, advisors are also available weekends from 8:00 a.m. – 8:00 p.m. Closed Thanksgiving Day, Christmas Eve, Christmas Day, New Year’s Eve, and New Year’s Day.
Using Your Benefits
You should receive your Univera Healthcare ID card and other information about your plan benefits within 10 days of your enrollment confirmation. Then, visit our section for members, which will take you through the steps you need in order to start taking advantage of your Univera Healthcare membership.
Information on medical facility locations, departments and services, and directions and phone numbers are available online. You also can contact Member Services and our health plan representatives will be happy to help you find the information that you need.
Call to speak with a pharmacy representative to assist you with transferring your prescriptions. When you call, please have your prescription number(s) and the pharmacy name and phone number ready — we’ll handle the rest.
You are covered worldwide for medically necessary emergencies or urgently needed care for a maximum of three to twelve consecutive months, depending on your plan. You will need to submit claim forms to be reimbursed for these services.
For more detailed information on coverage while traveling, please refer to your Evidence of Coverage or contact Member Services.
While temporarily outside the Univera Healthcare service area, coverage is limited to medically necessary emergencies, urgent care, and, for Univera Healthcare (HMO-POS) members, there is an annual out-of-network benefit of up to $3,000.
If you are outside of the service area for more than 3 to 12 months, depending on your plan, or move permanently outside of our service area, Medicare requires us to disenroll you from our plan. Call us, and we can help you with coverage when you travel or move.
You cannot be disenrolled because of your health status. Your membership can be terminated for other reasons, which may include, but are not limited to:
- failing to pay your Univera Healthcare premium, if one is required under your plan.
- moving permanently out of the service area.
- not maintaining your enrollment in Original Medicare.
There are a few other causes for disenrollment, which are explained in the Evidence of Coverage.
Univera Healthcare contracts with the Federal Government and is an HMO plan with a Medicare contract. Enrollment in Univera Healthcare depends on contract renewal. Submit a complaint about your Medicare plan at www.Medicare.gov or learn about filing a complaint by contacting the Medicare Ombudsman. Y0028_5996_C.
This page last updated 10-01-2019.