Rules to Know

Enrolling
Your Medicare-covered dependents and you can each choose the MA plan that is best for you, or both of you can be covered under the same plan.

If your dependents are not eligible to participate in an MA plan, they may continue coverage under their HMO or PPO plan.

You may enroll your covered dependents in an MA plan on the first of the month after they become eligible: (1) they become covered under Medicare Parts A & B at age 65; (2) they are under age 65 but become disabled and get Medicare Parts A & B; (3) they move into the service area of TexanPlus or Texas HealthSpring; or (4) for Aetna, they live in any of the 50 states.

If you enroll in an MA plan May 1, 2009, you may elect to return to the HMO or PPO within 90 days after enrolling, or January 1, 2010.

Click here for new rules about retirees adding dependents after May 1, 2009.

Disenrolling
You may disenroll from your MA plan effective the last day of any month by submitting a City of Houston Medicare Advantage Disenrollment form. You must also complete a City of Houston Retiree Medical Election Form to reinstate HMO, PPO or another MA plan coverage. Request these forms from the benefits division, 888-205-9266 or 713-837-9400. You must re-enroll in the HMO or PPO within 31 days after your coverage ends in the MA plan.

You must continue getting your medical services through your MA plan until you are notified by the plan that your coverage has ended. That notice can take up to 60 days.

Primary-care physicians
Under TexanPlus and Texas HealthSpring, you must select a primary-care physician to coordinate your health care, just as in the HMO. Check each plan’s provider directory. Your doctor might be in its network.

The Aetna PFFS plan allows you to select any doctor or specialist who accepts Medicare assignment and Aetna’s PFFS plan. Call your doctor. He/she might already have these arrangements in place.

Returning to original Medicare
Remember, your MA plan takes the place of your Medicare and your HMO or PPO. If you re-enroll in the HMO or PPO, you are also re-enrolled in Original Medicare.

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