Am I Eligible to Join?

You are eligible to enroll in an MVP Medicare Advantage plan if you:

  • Have Medicare Part A and Part B. You must continue to pay your Part B premium, and reside in the plan’s designated service area.
  • Live in Albany, Broome, Cayuga, Chenango, Columbia, Cortland, Dutchess, Erie, Fulton, Genesee, Greene, Herkimer, Livingston, Madison, Monroe, Montgomery, Niagara, Oneida, Onondaga, Ontario, Orange, Orleans, Oswego, Rensselaer, Saratoga, Schenectady, Schoharie, Seneca, Steuben, Tioga, Tompkins, Ulster, Warren, Washington, Wayne, Wyoming or Yates counties.

MVP will not refuse coverage based on your current health status or anticipated use of health care services unless you have end-stage renal disease. If you have end-stage renal disease, current federal law does not allow you to enroll in an MVP Medicare Advantage plan unless you are already an MVP member or have had a successful kidney transplant.

 

To Join an MVP Medicare Advantage Plan

Here are ways you can enroll:

1. Call 1-888-280-6205 to enroll right over the phone in minutes, or TTY users may call 1-800-662-1220.

OR

2. Click Here to Enroll Online

OR

3. Download the Application:

2012 East/Central Region (PDF)
(Albany, Fulton, Montgomery, Rensselaer, Saratoga, Schenectady, Schoharie, Warren, Washington, Broome, Cayuga, Chenango, Cortland, Herkimer, Madison, Oneida, Onondaga, Oswego, Tioga and Tompkins counties)

2012 Mid Hudson Region (PDF)
(Columbia, Dutchess, Greene, Orange and Ulster Counties)

2012 Rochester Region (PDF)
(Genesee, Livingston, Monroe, Ontario, Orleans, Seneca, Steuben, Wayne, Wyoming and Yates Counties)

2012 Buffalo Region (PDF)
(Erie and Niagara Counties)

If using the paper form, select your plan choice, and be sure to fill out one application for each person enrolling. Then sign and date the form(s). You can select your plan choice right on the application.

Send your completed application and payment to:
MVP Health Care
MVP Medicare Sales
220 Alexander St.
Rochester, NY 14607

We must receive your application no later than the last working day of the month to meet Medicare’s deadline for becoming effective the first day of the next month. For example, if we receive your application on January 31, your coverage will begin February 1.

Once You Join an MVP Medicare Advantage Plan

  • Joining MVP will automatically disenroll you out of any other Medicare Advantage plan or Medicare Prescription Drug plan in which you may currently be a member.
  • Your medical care will be covered by MVP. Your MVP plan takes the place of Medicare.
  • You will have an MVP member ID card. Keep your Medicare card for your records.
  • Always carry and show your MVP membership card when you visit your doctor or pharmacy.
  • If you sign up for Medicare prescription drug coverage (Part D) with MVP, you will receive your Medicare prescription drug benefit through MVP. If you also have prescription drug coverage through New York State’s EPIC program or a Veterans Administration program, that coverage may continue as well.
  • You will have virtually no claim forms to complete unless you receive services outside of the MVP network.
  • Emergency and post-stabilization services and renal dialysis are covered worldwide. Urgently needed care is covered throughout the United States.
  • MVP will not refuse coverage based on your current health status or anticipated use of health care services unless you have end-stage renal disease. If you have end-stage renal disease, current federal law does not allow you to enroll in an MVP Medicare Advantage plan unless you are already an MVP member or have had a successful kidney transplant.
  • The premiums and benefit packages for our plans may change at the beginning of each calendar year. They will not change during the calendar year unless the change is to your advantage as an MVP member.

A note about “prior authorization”

Some services require prior authorization by MVP regardless of whether these services are given in network or out of network. Prior authorization refers to a process in which MVP works with you and your doctors to make sure you receive medically-necessary, high-quality medical treatment at a reasonable cost. Some examples of services needing prior authorization include:

  • Admissions to transitional care units, acute rehabilitation, skilled nursing facilities
  • Durable medical equipment
  • Home care services
  • Implants and internal prosthetics

Most often, your family doctor will begin the process and request authorization whenever it is needed.

If you need or want a medical service not available within the MVP network, you may refer yourself to a doctor or service outside the network. Remember that it will cost you more to receive medical services outside of the MVP network.

Signing Up for Medicare Part D Drug Coverage

MVP's Medicare Advantage plans also offer Medicare prescription drug coverage (Part D). If you wish to join one of our Medicare plans and you also want prescription drug coverage, you must select Part D from MVP.

Note: If you do not join a Medicare Part D plan when you first become eligible, or have coverage as good as Medicare’s, you may have to pay a penalty if you join at a later date. The penalty can be 1% of the current premium for every month you delay enrollment for as long as you are enrolled in Part D coverage.

You may apply:

  • During the annual election period, from Oct. 15 through Dec. 7, 2011 to begin coverage on January 1, 2012.
  • If you lose creditable prescription drug coverage through your employer group or other source.
  • If you are eligible for New York state's EPIC (Elderly Pharmaceutical Insurance Coverage) program, you may be eligible to join Part D after December 31. To find out if you qualify, call EPIC at
    1-800-332-3742.
  • If you are eligible to receive Extra Help with prescriptions (called Low Income Subsidy). To find out if you qualify, call the Social Security Administration Office at 1-800-772-1213. TTY users should call
    1-800-325-0778. Or call the New York State Health Insurance Information, Counseling and Assistance Program at 1-800-333-4114.

Visit www.mvphealthcare.com for details on our Part D prescription drug plan.

If you have any questions, please call MVP Medicare Sales Monday through Friday, from 8 am – 5 pm Eastern Time at 1-888-280-6205. TTY users may call 1-800-662-1220.

Or call the MVP Medicare Customer Care Center Monday through Friday, 8 am — 8 pm and Saturday, 8 am — 4 pm at 1-800-665-7924. From October 15 — February 14, call us every day from 8 am — 8 pm at the above numbers.

MVP Health Plan, Inc. is a Federally-qualified not-for-profit HMO-POS/PPO with a Medicare contract. Plan availability and premium rates may vary by county.

The benefit information provided herein is a brief summary, not a comprehensive description of benefits. For more information, contact MVP. You must have both Part A and Part B to enroll, and continue to pay your Part B premium. 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). TTY users may call 1-877-486-2048, 24 hours a day/7 days a week; the Social Security Office at 1-800-772-1213 between 7 am and 7 pm, Monday through Friday. TTY users may call 1-800-325-0778; or your State Medicaid Office.

HMO-POS and PPO members may see doctors within and outside of the MVP network. However, with the exception of emergencies or urgent care, it will cost more to get care from out-of-network providers. You must use network pharmacies to access your prescription drug benefit, except under non-routine circumstances, and quantity limitations and restrictions may apply. Benefits, formulary, pharmacy network, premium and/or copayments/coinsurance may change on January 1, 2013. This document is available in other formats or languages. Call MVP at the above phone numbers for more information.