Part D Information

Plan Coverage Information

Plan coverage information is detailed in the documents below. Please select the document for your Carolina Medicare Prime Plan. These documents give you the details about your Medicare health coverage and explain how to get the care you need.

	Carolina Medicare Prime 10		Carolina Medicare Prime 15
	Carolina Medicare Prime 10 Plus		Carolina Medicare Prime 15 Plus
	Carolina Medicare Prime Prescription Drug Plan		Carolina Medicare Prime Plus Prescription Drug Plan

Information on How to Appoint a Representative

You may wish to have someone else discuss your coverage information. The person you name would be your appointed representative. You can name a relative, friend, advocate, doctor, or anyone else to act for you. Some other persons may already be authorized under State law to act for you. If you want someone to act for you, then you and that person must sign and date the form below, and send it to Express Scripts, Inc., P.O. Box 66773, St. Louis, MO 63166. This gives the person legal permission to act as your appointed representative. For more information you can call them at 1-800-570-1638 and 1-800-735-2905 (TTY) to learn how to name your appointed representative.

  Appointment of Representative form

Plan Grievance and Appeals Process

The document below will provide you with the process by which you may file a grievance. Federal law guarantees your right to make complaints if you have concerns or problems with any part of your care as a plan member. The Medicare program has helped set the rules about what you need to do to make a complaint and what we are required to do when we receive a complaint. If you make a complaint, we must be fair in how we handle it. You cannot be disenrolled from Carolina Medicare Prime or penalized in any way if you make a complaint.

A complaint will be handled as a grievance, coverage determination, or an appeal, depending on the subject of the complaint. The document below discusses grievances, coverage determinations, and appeals.

Please note this document addresses complaints about your Part D prescription drug benefits only. If you have complaints about your Medicare Advantage benefits, please consult your Evidence of Coverage document.

  Plan Grievance and Appeals

Contact Number for Enrollees with Grievance and Appeals Questions

1 (800) 570-1638

Contact Number for Physicians with Grievance and Appeals Questions

1 (800) 417-8164

General Contact Information

If you have any questions or concerns, please call or write to Carolina Care Plan Customer Relations. We will be happy to help you.

11 Things to Know About Medicare Part D

In 2006, Medicare began offering prescription drug coverage. Here are a few important things to know.

• On January 1, 2006, Medicare began offering insurance coverage for prescription drugs through Medicare prescription drug plans and other health plan options.
• Insurance companies and other private companies will work with Medicare to provide a choice of plans that cover both brand name and generic drugs.
• To enroll, you must have Medicare Part A and Part B. For 2007, you can enroll in a plan in your area from November 15, 2006 through December 31, 2006.
• If you have limited income and resources, you may qualify for extra help that will cover between 85 and almost 100 percent of your drug costs. Most people who are eligible for this extra help will pay no premiums, no deductibles, and no more than $5.35 for each prescription. The amount of extra help depends on your incomes and resources.
• Throughout the year, Medicare will provide more information about Medicare prescription drug coverage, retiree options, and help for people with limited income and resources. Medicare will also provide information on how to choose and join a drug plan that meets your needs.
• Medicare prescription drug plans will vary, but all plans must offer coverage that is as good as the Medicare minimum standard coverage.
• If you enroll by December 31, 2006, your Medicare prescription drug plan coverage will begin on January 1, 2007. You will not miss a day of coverage. If you enroll after December 31, 2006, your coverage will begin the first day of the month after the month you join. It is important that you join a Medicare prescription drug plan when you are first eligible.
• If you were eligible to join a Medicare prescription drug plan but did not join by May 15, 2006, you are likely to pay a higher monthly premium. Your premium will be at least 1% more for every month you waited to get a Medicare prescription drug plan. You will not have to pay a higher premium if you currently have a drug plan that covers at least as much as a Medicare prescription drug plan.
• You have two choices. You can choose to take advantage of this coverage by joining a Medicare prescription drug plan that covers prescription drugs only. You can also join a Medicare Advantage or other Medicare Health Plan that covers your doctor and hospital care as well as your prescriptions.
• Medicare is working with your Medicare Advantage or other Medicare Health Plan to help them provide even more coverage or lower the cost of your existing coverage. This October, your plan will let you know about the prescription drug options they will offer.
• If you are already enrolled in a Medicare Advantage plan, and you choose to enroll in a separate Medicare Part D prescription plan, you will automatically be disenrolled from your Medicare Advantage plan and will revert to standard Medicare enrollment. If this occurs, you will not be able to return to your Medicare Advantage plan until the next open enrollment period, which occurs each November.

For more information, visit http://www.medicare.gov/pdphome.asp.