Medicare Advantage and Medicare Advantage with Prescription Drug Plans:
M0013_10_072, 03/16/2010
Last Updated 03/16/2010

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The Medicare Contract is renewed annually, and the availability of coverage beyond the end of the current year is not guaranteed. You are eligible to enroll if you are entitled to Medicare Part A and enrolled in Medicare Part B and you live in the service area. You must continue to pay your Medicare Part B premium if not otherwise paid for under Medicaid or by another third party. With some exceptions you can only enroll during certain times of the year.

If you decide to switch to premium withhold or move from premium withhold to direct bill, it could take up to three months for it take effect and you will ultimately be held responsible for those premiums.

Medicare beneficiaries may enroll in our Medicare Advantage and Part D plans through the Centers for Medicare & Medicaid Services Online Enrollment Center, located at www.medicare.gov. For more information please contact our Customer Service Department.

Please reference the Evidence of Coverage for information rights and responsibilities upon disenrollment, and any applicable conditions associated with using the plan benefits.

For information on the availability of other formats, or full information on Plan benefits please call our Customer Service Department.

You may be able to get Extra Help to pay for your prescription drug premiums and costs. To see if you qualify for getting Extra Help, call:

• 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048, 24 hours a day/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 State Medicaid Office.

Medicare Supplement Plans:

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Services provided by Empire HealthChoice Assurance, Inc., licensee of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield plans. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association.