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Each Medicare Advantage plan with prescription drug coverage or Part D plan has its own list of covered drugs, called a formulary. Our pharmacy department partners with physicians from other health systems who are specialized in their field to dec...
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Last Updated: 10/01/2024
in Medicare Your Pharmacy Info A biosimilar is a highly similar product to the original biologic medication already approved by the Food and Drug Administration (FDA). Biosimilars are made with the same types of natural products and administered in similar ways. Biosimilars have ...
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To find your member ID, you can refer to your FirstCarolinaCare or FirstMedicare Direct ID card. The member ID is printed on the card with other important information like copayment/coinsurance details. If you don't have your ID ca...
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Last Updated: 10/01/2024
in Medicare Your Hally Account
How do I order a new ID card? How can I check my claims? - Not available on our SmartHMO plan. How can I request or see my prior authorizations? What is my spending on services? ...
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For a Medicare Part D plan, you'll pay: A set monthly premium. A Part D deductible (if applicable). Copayments or coinsurance for your drug costs. All your other Medicare or Medicare Supplement costs. Medicare Part C plans may include Medicare...
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Last Updated: 10/01/2024
in Medicare
When the Centers for Medicare & Medicaid Services (CMS) makes changes to the services that are covered, they update them through National Coverage Determinations. Learn more about National Coverage Determinations on their website . ...
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Last Updated: 10/01/2024
in Medicare You, your authorized representative, or your prescribing doctor can ask for a coverage determination. Your provider can submit prior authorization requests through the GuidingCare Provider Portal. Mail or fax us a Coverage Determination Request...
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Last Updated: 10/01/2024
in Medicare
In crises like tornadoes, hurricanes, earthquakes, floods and fires, if the Governor of your state, the U.S. Secretary of Health and Human Services, or the President of the United States declares a state of disaster or emergency in your geographic...
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The Part D late enrollment penalty is a an amount added to your Part D monthly premium because you didn't sign up for drug coverage when it was available to you. If you go without a Part D plan or a Medicare Advantage plan with drug coverage for 6...
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An exciting change has been made to your coverage – here’s what you need to know. Starting January 1, 2025, there is no longer a “Coverage Gap,” also called the “Donut Hole” Phase, in your prescription drug plan. This means that once you reach t...