Medicare Advantage Plan Rules to Know

  1. 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.
  2. If your dependents are not eligible to participate in an MA Plan, they may continue coverage under their HMO or PPO plan.
  3. 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 their network.
  4. The Aetna PFFS plan allows you to select any doctor or specialist that accepts Medicare and Aetna’s PFFS plan. Call your doctor. He/she might already have these arrangements in place.
  5. 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 PFFS, they live in either of the 50 states.
  6. You may disenroll from your MA plan effective the last day of any month by submitting a disenrollment form. 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.
  7. If you disenroll from an MA Plan, you may re-enroll in the HMO or PPO within 31 days after your coverage ends in the MA Plan. You should request re-enrollment at the same time that you apply to disenroll from your MA Plan. After 31 days, you will lose the opportunity to re-enroll in the HMO or PPO.
  8. If you enroll in an MA Plan, you may elect to return to the HMO or PPO within 90 days after enrolling, or
    May 1, 2008. You must complete a City of Houston Medicare Advantage Disenrollment form and a City of Houston Retiree Medical Election Form. Request these forms from the Benefits Division, (888) 205-9266 or
    (713) 837-9400.
  9. 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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