Medicare Eligibility

Eligibility Restrictions

There are limits to when and how often you can change the way you get Medicare and what choices you can make when you make the change.
 

Here are the rules:

From October 15 through December 7, anyone with Medicare can change the way they are getting Medicare for the following year.
 
With this change, you are limited to the type of plan you may join. If you have Medicare prescription drug coverage when making your change, you will only be able to join another plan that has Part D prescription coverage or you will have to go to original Medicare and join a Prescription Drug Plan.  If you do not have Medicare prescription drug coverage when making this change, you will only be able to join a Medicare Advantage plan with medical-only benefits or go to Original Medicare.
 
Generally, you can't make any other changes during the year unless you meet special exceptions, such as if you move or if you have Medicaid coverage. To qualify for FirstCare Advantage Dual SNP (HMO SNP) you would need to have Medicare and Medicaid which would allow you to enroll.
 Contact us for information at 1-866-229-4969. Later in the year, from October 15 through December 7, anyone with Medicare can switch their way of getting Medicare to another way for the following year.
 
If you join another Medicare plan, including a Medicare Prescription Drug Plan, you will be disenrolled from our plan when your enrollment in the new plan begins. If you leave your current plan and don't join a plan that offers Medicare prescription drug coverage or a Medicare Prescription Drug Plan, and you don't have prescription drug coverage that is at least as good as the Medicare standard prescription drug benefit, you may have to pay a late enrollment penalty (higher premium) if you decide to join later. This means your monthly premium will be higher.

In most cases, your effective date is generally the first day of the month that comes after the month we receive your request.  For example, if we receive your request during the month of February, your effective date will be March 1.
 
The Centers for Medicare & Medicaid Services (CMS), the government agency that oversees Medicare, prohibits enrollment of anyone with End-Stage Renal Disease (ESRD) into a Medicare Advantage plan.  However, individuals with ESRD who are currently enrolled in FirstCare Advantage Dual SNP (HMO SNP) health plan as a non-Medicare member, individuals who lose coverage due to another Medicare Advantage plan withdrawing from the market after December 31, 1998, or individuals who no longer require dialysis are eligible to join. 

Contact FirstCare Advantage Dual SNP (HMO SNP) if you have questions.  Hours are:
October 1 – March 31, 8 a.m. to 8 p.m. Central Time (CT) daily;
April 1 – September 30, 8 a.m. to 8 p.m. Central Time (CT) Monday through Friday.

 
 

Resources

Virtual Care Powered by MDLive

We've teamed up with MDLIVE to provide our members with access to Telehealth visits to board-certified doctors, pediatricians, licensed therapists and more- using your smartphone, tablet or desktop.  ***Available January 1, 2019***

Talk to a Nurse—Nurse24™

Need care advice? Should you see a doctor? Get the info you need today! FirstCare members can talk to a nurse 24/7 by calling 1.855.828.1013 to get answers 24 hours a day, 7 days a week! TTY users can call 7-1-1 or  1.800.955.8771. Voice communication is available at 1.800.955.8770.

Utilization Management

Ever wonder how we decide what services to authorize? Our utilization management (UM) decisions are based on medical evidence and consensus of health care professionals. For more details, click here.

How to Learn More

Schedule a sit-down:
Feel free to contact us, and a FirstCare Advantage Dual SNP (HMO SNP) representative will gladly sit down with you and compare the plans in greater detail.
 
Call us at:
1- 866- 229-4969
We are available;
October 1- March 31, 8 a.m. to 8 p.m. Central Time (CT) daily;
April 1- September 30, 8 a.m. to 8 p.m. Central Time (CT) Monday through Friday.
 
For TTY or for accommodation of persons with special needs, please call TTY 1-800-562-5259.
 
Or, write:
FirstCare Advantage Dual SNP (HMO SNP)
Attn:  Customer Service
1901 West Loop 289, Suite 9
Lubbock, TX 79407

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