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Available to Medicare Beneficiaries who meet the requirements for long-term care eligibility.
Available to Medicare beneficiaries with a diagnosis of dementia.
People with Medicare who want to join a Medicare Advantage Plan
To join a plan, you must:
Important: To join a Medicare Advantage Plan, you must also have both:
You can join plan:
Visit Medicare.gov to learn more about when you can sign up for a plan.
Note: You must complete all items in Section 1. The items in Section 2 are optional — you can’t be denied coverage because you don’t fill them out.
Once they process your request to join, they’ll contact you
Call PruittHealth Premier at 1-855-855-0668 (TTY 711) 1-855-855-0759 (TTY 711) 1-855-855-0759 (TTY 711).
Or, call Medicare at 1-800-MEDICARE (1-800-633- 4227). TTY users can call 1-877-486-2048.
En español: Llame a PruittHealth Premier al 1-855-855-0668 (TTY 711) 1-855-855-0759 (TTY 711) 1-855-855-0759 (TTY 711) o a Medicare gratis al 1-800-633-4227 y oprima el 2 para asistencia en español y un representante estará disponible para asistirle.
If you want to join a plan but have no permanent residence, a Post Office Box, an address of a shelter or clinic, or the address where you receive mail (e.g., social security checks) may be considered your permanent residence address.
According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0938-1378. The time required to complete this information is estimated to average 20 minutes per response, including the time to review instructions, search existing data resources, gather the data needed, and complete and review the information collection. If you have any comments concerning the accuracy of the time estimate(s) or suggestions for improving this form, please write to: CMS, 7500 Security Boulevard, Attn: PRA Reports Clearance Officer, Mail Stop C4-26-05, Baltimore, Maryland 21244-1850.
IMPORTANT Do not send this form or any items with your personal information (such as claims, payments, medical records, etc.) to the PRA Reports Clearance Office. Any items we get that aren’t about how to improve this form or its collection burden (outlined in OMB 0938-1378) will be destroyed. It will not be kept, reviewed, or forwarded to the plan. See “What happens next?” on this page to send your completed form to the plan.
We value you as a member and want to share how your benefits will change, starting April 1,2023.
Under the Part B Rebatable Drug Coinsurance Adjustment provision, beginning April 1, 2023, coinsurance for Part B rebatable drugs will be reduced, if the drug’s price has increased at a rate faster than the rate of inflation.
CMS will publish the adjusted beneficiary coinsurance for each Part B rebatable drug in the quarterly pricing files posted on the CMS website, as a 0-20% effective coinsurance of the Medicare-approved payment amount.
Part B rebatable drugs may be in either of the categories “Chemotherapy administration services to include chemotherapy/radiation drugs” or “Other drugs covered under Part B of original Medicare” listed in § 422.100(j)(1)(i). The list of Part B rebatable drugs as well as the effective beneficiary coinsurance for those drugs could change each quarter.
For questions about this document, please contact our Member Services number at 1-855-855-0668 (Georgia) and 1-855-855-0759 (North Carolina / South Carolina) for additional information. (TTY users should call 711). Hours are 8 a.m. to 8 p.m., seven days a week (except Thanksgiving and Christmas) from October 1 through March 31, and Monday to Friday (except holidays) from April 1 through September 30.
June 1, 2023
We value you as a member and want to share how your benefits will change, starting July 1,2023.
Under the Part B Insulin Cost Sharing Cap, beginning July 1, 2023, Insulin furnished under Part B through an item of durable medical equipment covered under section 1861(n) (i.e., a medically necessary traditional insulin pump), is subject to a beneficiary coinsurance cap for a month’s supply of such insulin (that does not exceed $35 and the Medicare Part B deductible does not apply).
Please contact our Member Services number at 1-855-855-0668 (Georgia) and 1-855-855-0759 (North Carolina / South Carolina) for additional information. (TTY users should call 711). Hours are 8 a.m. to 8 p.m., seven days a week (except Thanksgiving and Christmas) from October 1 through March 31, and Monday to Friday (except holidays) from April 1 through September 30.
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