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* You must continue to pay your Part B Premium
** These services are neither offered nor guaranteed under our contract with the Medicare program. In addition, they are not subject to the Medicare appeals process. Any disputes regarding these products and services may be subject to the Medica grievance process
Need Extra Help with Medicare Part D?
You may be able to get extra help to pay for your prescription drug premiums and costs. See our Low Income Subsidy Summary Table for Medica Prime Solution Basic and Enhanced Plan with Modified Standard or Enhanced Prescription Drug Coverage for potential rates. To learn more, contact:
- 1-800-MEDICARE (1-800-633-4227) 24 hours a day, seven days a week. TTY/TDD users should call 1-877-486-2048;
The Social Security Administration at 1-800-772-1213 between 7 a.m. and 7 p.m, Monday through Friday. TTY/TDD users should call 1-800-325-0778; or
Your State Medicaid Office
How to Enroll:
Complete the Medica Prime Solution Application Form and any chosen Rider application. Attached above and mail or fax to Medica. How to Contact Us. Please review the summary of benefits before enrolling.
For a complete copy of your medical policy, including coverage terms, exclusions, contract termination, members' rights and responsibilities, and other information, please refer to the - 2010 Evidence of Coverage for the specific product.
H2450_2279 (XX-2009)
Content updated 10/01/2009 - pending CMS approval |