2020 Ponce de Leon Blvd, Suite 901. Coral Gables, FL 33134   
  

Other Important Information

Information on Receiving Extra Help and Savings Benefits

Did you know you could qualify for extra help and savings benefits?

Medicare Savings Programs These are state programs that assist individuals with limited income paying with their Medicare costs. The names of these programs may vary by state. The state can help individuals paying for Medicare premiums. In some cases, Medicare Savings Programs may also pay Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance) deductibles, coinsurance and copayments if certain conditions are met.

Low Income Subsidy (LIS) – A program to help individuals pay for Medicare Prescription Drug costs, that it is also called “Extra Help”. Medicare beneficiaries receiving LIS may be able to qualify for assistance in paying for their Part D monthly premium, annual deductible, coinsurance and copayments. The amount of subsidy depends on the individual’s income compared to the Federal Poverty Level and resource limitations set by the Social Security Act.

Doctors HealthCare Plans LIS Premium Summary Table 2019

Monthly Premium for the Plans
Your level of extra help DrPlus (D-SNP)* DrMax (HMO-POS)* DrCare (C-SNP)* DrExtra (C-SNP)*
100% $0.00 $0.00 $0.00 $0.00
75% $7.58 $0.00 $0.00 $0.00
50% $15.15 $0.00 $0.00 $0.00
25% $22.73 $0.00 $0.00 $0.00
0% $30.30 $0.00 $0.00 $0.00
*This does not include any Medicare Part B premium you may have to pay.

For more info and to see if you qualify you may also call us at 1-833-342-7463, TTY users should call 711. We are open Monday through Sunday from 8a.m. – 8p.m.  You may also contact:

Centers for Medicare & Medicaid Services
Website: www.medicare.gov
Toll-free phone: 1-800-633-4227
TTY: 1-877-486-2048
24 hours a day, seven days a week

Social Security Administration
Website: http://www.socialsecurity.gov/prescriptionhelp
Toll-free phone: 1-800-772-1213
TTY: 1-800-325-0778
Monday through Friday 7 a.m. to 7 p.m.

Department of Children and Families (DCF)
Florida Partner Website at www.myflorida.com/accessflorida

Phone: 1-866-762-2237
TTY users should call 1-800-955-8771 or 1-800-955-8770

Best Available Evidence

Doctors HealthCare Plans must accept certain forms of evidence of Extra Help or Low Income Subsidy (LIS) assistance when our system or CMS’ system does not indicate that you are eligible for this assistance. The Best Available Evidence page on the CMS website gives examples of the information you should provide to us.  https://www.cms.gov/Medicare/Prescription-Drug-Coverage/PrescriptionDrugCovContra/Best_Available_Evidence_Policy.html

Doctors HealthCare Plans Quality Improvement and Management

Doctors HealthCare Plans, Inc. (the Plan), continually strives to improve quality of care and services for our Members.  For more information please see below:

Quality Improvement and Management

National Coverage Determinations (NCD)

National Coverage Determinations (NCDs) are binding on all Medicare contractors, quality improvement organizations and health maintenance organizations. From time-to-time CMS makes changes to the services that are covered by Medicare. These changes are updated via National Coverage Determinations. You can access the NCD information by using the link below.

https://www.cms.gov/Medicare/Coverage/InfoExchange/index.html

Florida Bill of Rights and Responsibilities

Florida law requires that your healthcare provider or healthcare facility recognize your rights while you are receiving medical care and that you respect the healthcare providers’ or facility’s right to expect certain behavior on the part of patients.

Florida Bill of Rights and Responsibilities

Agency for Health Care Administration Rules and Services

The Agency for Health Care Administration (AHCA) is responsible for the administration of the Florida Medicaid program.   Below is the AHCA website address. The site contains rules and services specific policies.  Please use this as a resource to better understand Medicaid benefits and services.

http://ahca.myflorida.com/medicaid/review/specific_policy.shtml

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Last Updated: 09/13/2018

 

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