Below are frequently asked questions and their answers. However, if you don’t find what you’re looking for please call Member Services at 1-800-799-0927 (TTY/TDD users should call 711). 8am to 8pm, 7-Days a week from October 1 – March 31 and Monday through Friday from April 1 – September 30.
Q: Who can get Medicare Part D?
A: Everyone who is eligible for Medicare is also eligible for Part D prescription drug coverage.
Q: Things to know about enrolling in Medicare Part D.
A: You can choose to join in a standalone Part D plan or a Medicare Advantage plan with drug coverage when you first become eligible for Medicare. You can also enroll in a plan or change plans during the Medicare Annual Enrollment Period, which occurs every year from October 15 through December 7. You want to sign up for Part D as soon as you become eligible. Unless you qualify for a Special Enrollment Period, you might be charged a late enrollment penalty if you delay enrollment.
In general, you may enroll in a Part D plan if you are entitled to Medicare Part A or if you are enrolled in Medicare Part B. In addition, you must live in the service area of the Part D plan.
Q. How do I apply for Medicare?
A. If you plan to retire at 65, and aren’t receiving Social Security benefits, apply through your local Social Security office up to 3 months before your 65th birthday. You may have to pay a late enrollment penalty if you sign up more than 3 months after you turn 65.
- If you’re already receiving Social Security benefits, you don’t need to apply for Medicare. You’ll be automatically enrolled.
- If you or your spouse plan to continue working after age 65 and are covered under a group plan, it might not be in your best interest to sign up for Medicare Part B right now. Contact your local Social Security office or your group benefits administrator for information.
Q. How do I get a Medicare card?
A. As soon as 3 months before your 65th birthday contact Social Security through one of the following:
- Go to Social Security online services. Please note: by clicking on this link you will be leaving the Indy Health website.
- Visit your local Social Security office
- Call Social Security at 1-800-772-1213 (TTY 1-800-325-0778), 7 a.m. to 7 p.m., Monday through Friday.
Q. How much does Medicare Cost?
A. For most people, there is no premium for Medicare Part A (hospital insurance).
There is a monthly premium for each of the following:
- Medicare Part B (medical insurance)
- Medicare supplement plan
- Medicare prescription drug plan
- Some Medicare Advantage plans
Q. What does Best Available Evidence (BAE) mean?
A. The “best available evidence” policy is a CMS requirement for plans to establish appropriate cost-sharing for low-income beneficiaries when presented with evidence that the beneficiary’s information from CMS was not accurate. Part D plans are required to work with pharmacies to resolve these issues at point-of-sale when beneficiaries provide appropriate evidence of correct low-income status.
More information can be found on the Medicare website. Please note: by clicking on this link you will be leaving the Indy Health website.
Q. What is an Authorized Representative?
A. An Authorized Representative is someone you appoint to act on your behalf by submitting the Appointment of Representative form to Indy Health Insurance Company. You can also use a form directly from Medicare to assign this. That document can be found here: https://www.cms.gov/Medicare/CMS-Forms/CMS-Forms/CMS-Forms-Items/CMS012207.html. Please note: by clicking this link you will be leaving the Indy Health Insurance website.
Q. How can I enroll in Indy Health?
A. You can enroll online, by mail, or by phone.
Q. When do I get my Member ID card?
A. We mail Member ID cards to members within ten days of enrollment. You can also call Member Services to order a new ID card.
Q: If I don’t enroll, will Medicare automatically enroll me in its prescription drug plan and begin deducting the premium from my Social Security checks?
A: No. To be enrolled in Part D, you must enroll through one of the prescription drug companies that offers the Medicare Part D Plan.
Q: Do I have to enroll in Medicare Part D to keep Parts A and B?
A: No. Medicare Part D is completely separate from the existing Parts A and B of Medicare.
Q: My spouse and I are both eligible for Part D. Do we have to enroll separately?
A: If you want Part D coverage, you must enroll separately. You or your spouse can enroll even if the other chooses not to.
Q: Do I have to be a U.S. citizen and a legal resident.
A: Legal residents must live in the U.S. for at least 5 years in a row, including the 5 years just before applying for Medicare.
Q: What are other enrollment requirements?
A: You must also meet one of the following requirements:
- Age 65 or older
- Younger than 65 with a qualifying disability
- Any age with a diagnosis of end-stage renal disease (ESRD) or amyotrophic lateral sclerosis (ALS).
Q. What do I do if I have secondary prescription coverage?
A. Please call our Member Services at 1-800-799-0927 (TTY/TDD users should call 711). 8am to 8pm, 7-Days a week from October 1 – March 31 and Monday through Friday from April 1 – September 30. They will provide information on the steps that need to be taken.
Q. How can I check my enrollment status?
A. Please call our Member Services at 1-800-799-0927 (TTY/TDD users should call 711). 8am to 8pm, 7-Days a week from October 1 – March 31 and Monday through Friday from April 1 – September 30.
Q. What happens if I move out of the service area?
A. If you’re outside of the service area for more than 3 to 12 months (depending on your plan), or move permanently outside of our service area, Medicare requires us to disenroll you from our plan. Call us, and we can help you with coverage when you travel or move.
Q: Is the estimated monthly premium per individual or per couple? What about the deductible?
A: Because you and your spouse must enroll separately, the premiums and the deductibles are per person.
Q. How often will I be billed?
A. Indy Health will bill your premium monthly.
Q. Will I receive a coupon book?
A. No, you will receive a monthly statement from Indy Health.
Q. How do I pay my plan premiums?
A. You can pay your premiums a variety of ways:
- You can have your monthly plan premium deducted from your Social Security/ Railroad Retirement Board benefit check (just like your Part B premium) or you can pay your premium to Indy Health Insurance directly.
- Premium payments may be made by check or electronic funds transfer (EFT) from your checking or savings account (EFT available Q2 2021).
Q. When will premiums get deducted from my account?
A. Once EFT goes live, premiums will be deducted the 10th of the month. If the 10th of the month falls on a weekend or holiday, the deduction will occur on the business day before the weekend or holiday.
Q. Will I get an invoice if I am getting automatic payments withdrawn from my account?
A. If you are enrolled in automatic monthly payments, you will not receive a monthly invoice.
Q. I am paying through Social Security deductions. Will I still get a bill?
A. No, you will not receive a monthly invoice if you are paying through Social Security Deductions or your Railroad Board Retirement Benefit
Q. Why is there a premium penalty on my bill?
A. The premium penalty on your invoice is a Late Enrollment Penalty (LEP). This is a financial penalty incurred by Medicare beneficiaries who had a gap in coverage for a continuous period of 63 days or more after the end of the beneficiaries Initial Enrollment period (IEP).
Q. What is Extra Help?
A. The Medicare Extra Help program is designed to help people who may not be able to afford prescription drug coverage by assisting with the costs of a Part D plan. This may include premiums, deductibles and/or coinsurance.
You may be able to get Extra Help to pay for your prescription drug premiums and costs. To see if you qualify for Extra Help, call:
- 1-800-MEDICARE (1-800-633-4227), 24 hours a day, 7 days a week. TTY users should call 1-877-486-2048, or visit www.medicare.gov. Please note: by clicking on this link you will be leaving the Indy Health website.
- Social Security Administration 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 go to the Social Security Administration’s website, Please note: by clicking on this link you will be leaving the Indy Health website.
- Your State Medicaid Office.
Q. What pharmacies are in the Indy Health network?
A. Indy Health has over 22,000 pharmacies in our pharmacy network. Independent pharmacies, which are your local non-pharmacy chain pharmacies, are part of the preferred network. By utilizing one of these pharmacies, you will receive a lower cost share on your prescriptions.
Q. Can I get my prescriptions through Mail Order?
A. Indy Health does not have a mail order benefit. We will cover a 90-day supply of medication at retail and some local independent pharmacies will mail your prescriptions to you.
Q. What happens if I fill my prescriptions at a pharmacy that is not in the Indy Health pharmacy network?
A. We may cover drugs filled at an out-of-network pharmacy only if there are no participating pharmacies near you and in an event of an emergency as defined by the plan. (Up to a 30-day supply only). Call Member Services to see if there is a network pharmacy in your area, and if not, verify that Indy Health will allow an out of network pharmacy before you fill your prescription.
If you do go to an out-of-network pharmacy due to a health emergency, you may have to pay the full cost (rather than paying just your copayment), when you fill your prescription. You can submit a claim form for reimbursement by downloading and submitting a reimbursement form. This form must be completed and returned along with your original paper receipt from the pharmacy within 90 days of receiving your prescription. Reimbursement will be the amount that we would have paid if you had the prescription filled at a network pharmacy. The amount that you paid may still be counted towards your required out-of-pocket costs. Please mail the form and receipts to Indy Health Insurance Company at the following address:
MedImpact HealthCare Systems Inc
P.O. Box 509098
San Diego, CA 92150-9098
For more information about outside network pharmacies, please reference your Evidence of Coverage or find a pharmacy near you with our pharmacy network search tool.
Q. I don’t see my drug listed on the formulary. What do I do?
A. Indy Health Insurance provides a transition period during the first 90 days you are with the plan to allow time for you to continue on your current medication, while you and your physician discuss your alternative medication treatment options which are on the formulary. You may also request a coverage decision.
Q. How do I request a coverage decision?
A. To request a coverage decision, on prescription drug you want but have not received, or to receive reimbursement for a prescription you paid out of pocket for, contact Member Services or visit our coverage decision page.
A response for a standard request can take up to 72 hours upon receipt of supporting documentation and a response for an expedited request will be made within 24 hours of receipt of supporting documentation. If your request is denied, you may seek an appeal.
Q: How do I make a complaint about Indy Health’s process or services?
A: If you’re unhappy with the services you are receiving, or if you’re unhappy with our processes, you can make a complaint. This is also known as filing a grievance. Call or write to Member Services within 60 days of the incident. Click here to learn more information.
We’ll look into your complaint and give you our answer within 30 calendar days. For additional details, refer to your Evidence of Coverage.
You also may use the online Medicare Complaint Form to transmit a complaint directly to Medicare. Please note: by clicking on this link you will be leaving the Indy Health website.
Q. How do I recognize and report fraud?
A. Protect your identity. Don’t give your Medicare claim number, or other plan information, to anyone other than your plan and care providers.
Look out for signs of fraud or suspicious offers. Some examples:
- Prescription fills displayed on your Explanation of Benefits (EOB) form you never received
- Bribes to get you to see an unfamiliar doctor or use services you don’t need
Visit the Medicare website for more information on preventing fraud. To report suspected fraud, call the toll-free number 1-877-7SAFERX (1-877-772-3379). Please note: by clicking on this link you will be leaving the Indy Health website.