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Understanding Medicare

Elite Health Plan is a Medicare Advantage Prescription Drug HMO with a contract with Medicare. Each calendar year, we apply to CMS to be contracted for the following year. We look forward to serving you as your partner in your healthcare journey.

What is Medicare?

Medicare is a federal health insurance program primarily for individuals aged 65 and older, as well as certain younger individuals with disabilities or specific health conditions.

Overview of Medicare

Medicare is divided into different parts, each covering specific services:

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Medicare Part A (Hospital Insurance): Covers inpatient hospital stays, skilled nursing facility caree, hospice care, and some home health care. Most people do not pay a premium for Part A if they or their spouse paid Medicare taxes for at least 10 years.

 

Medicare Part B (Medical Insurance): Covers outpatient care, doctor visits, preventive services, and some home health care. Part B requires a monthly premium, which is set annually. It’s very important to keep up to date with paying your Part B premium. This is a separate premium from any Plan premium and helps to maintain your benefit. 

 

Medicare Part C (Medicare Advantage): Elite Health Plan has a contract with CMS to offer a Medicare Advantage Plan. We have to offer coverage from both Part A and Part B. We also have additional supplemental benefits.

 

Medicare Part D (Prescription Drug Coverage): In addition to our Medicare Advantage Part C plan, Elite Health Plan combines the offering with Part D. Part D provides coverage for prescription medications. While there are drugs covered under Part B, a good portion of the normal prescriptions you’ll receive are under part D. We have a drug list (formulary) that provides you information about what Elite Health Plan covers and any costs, limitations and requirements.

Elite Health Plan
Medicare Advantage Prescription Drug Plan

We want you to get the most out of your Elite Health Plan. In this section, you’ll find resources to help you get started, understand your benefits, use online tools, learn about claims, and more.

Helpful Documents

Once enrolled in an Elite Health Plan Medicare Advantage plan, you’ll have access to important documents that explain your coverage and guide you in using your plan with confidence.

Annual Notice of Change (ANOC)

While Elite Health Plan will be new for 2026, beginning next year and each year after, you will receive an Annual Notice of Change from Elite Health Plan in September. This document explains any updates to your plan for the coming year, effective January 1st. It highlights expected changes to premiums, benefits, or coverage so you know exactly what to expect.

Evidence of Coverage (EOC)

Your Evidence of Coverage is an important document. It provides you with a detailed overview of your plan benefits, your rights and responsibilities, what is covered, costs you may pay as a member, how to file a complaint if you're not satisfied, and much more. You can access a copy under our members forms and resources. You can also request a hard copy.

Learn About Your Costs and Coverage

Coinsurance and Copays

​​Understanding Costs: With Elite Health Plan Medicare Advantage, you may hear the terms coinsurance and copay. Coinsurance is a percentage of the bill you pay, while copays are a set amount you pay at the time of service. For more details, please see your Evidence of Coverage.

Quick Facts About Claims and More

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  • Claims Filing: Your provider or pharmacy will typically file claims for services or prescriptions on your behalf. Once processed, you will receive a statement called the Explanation of Benefits (EOB).

  • What is an EOB? An EOB is not a bill. It details what you have paid, what Elite Health Plan has covered, and the level of benefits used.

  • How to use an EOB: Review your EOB carefully to ensure accuracy. If you spot an error or suspect fraud, contact Elite Health Plan customer service right away.

Is My Care Covered?

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It’s easy to ask questions or check what’s included in your Elite Health Plan Medicare Advantage coverage. If you’re unsure about your benefits, you can:

  • Read the Evidence of Coverage (EOC): This document outlines what is covered, what you may pay, and how to file a complaint if you’re unsatisfied with a decision or treatment.

  • Call Customer Service: After enrolling, use the phone number on your member ID card to reach an Elite Health Plan representative who can explain your plan benefits.

Prescription Drug Coverage

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Elite Health Plan Medicare Advantage plans include coverage for a wide variety of prescription drugs. Each plan comes with its own drug list (formulary) that covers both generic and brand-name medications. These lists also note any requirements such as prior authorization, quantity limits, or step therapy. Find out more here.​

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Drug Formulary​

Your Elite Health Plan Drug Formulary is a complete list of covered medications, updated each year. You can access it as a document or online tool. Share the formulary with your doctor to ensure prescriptions are covered. Any annual updates take effect at the start of each plan year. For more details, please see your Formulary.​​

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Medication List

Keep an up-to-date Medication List that includes your current prescriptions, directions, prescribers, and any known allergies. Bring this list when visiting your doctor, hospital, or in case of emergency. Sharing it with your family or caregivers helps ensure safe and accurate care. Find the Personal Medication List document here.

For additional information

Go to the Medicare.Gov page: 

Welcome to Medicare | Medicare

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