If you are enrolled in a medicare plan with part d prescription drug coverage, you may be eligible for financial extra help to assist with the payment of your prescription drug premiums and drug purchases. Humana is a medicare advantage hmo, ppo and pffs organization and a standalone prescription drug plan with a medicare contract. Plans have a yearly limit on what you pay medicare. Strategic formulary design in medicare part d plans ncbi nih. People with medicare who have part a but not part b. Part d drug plans have a formulary, or a list of the drugs, strengths, dosages, and routes of administration. Complete the application for enrollment in medicare form cms 40b enclosed for both you and your covered spouse if your spouse is age 65 or older. Express scripts medicare pdp 2017 formulary list of. The gep runs from january 1 through march 31 of each year. Your guide to medicare prescription drug coverage medicare. When it refers to plan or our plan, it means express scripts medicare.
Fill out an appointment of representative form cms form. I want to make sure medicare can give my personal health information to someone other than me authorization to disclose personal health information formcms10106. For more recent information or other questions, please for more recent information or other questions, please contact fhcps member services, at 18776154022 or, for tty users, trs relay 711. Fill out authorization to disclose personal health information. To get the medicare form you need, find the situation that applies to you. If you dont have part a, the procedure of signing up for medical insurance will differ, for details you should contact your local ssa office. Medicare prescription drugs list and rx availability humana. If you are eligible to enroll under the special enrollment period and unable to mail your cms 40 b, application for enrollment in medicare part b medical insurance along with the cms l564 request for employment information, and proof of employment, group health plan ghp, or. Enrollment in any humana plan depends on contract renewal. You may have to pay a late enrollment penalty if you sign up during the gep. The design of medicare part d causes most beneficiaries to receive. If you do not have part a, do not complete this form.
Oxycontin has been removed from the formulary due to concerns for patient safety. Prior avalere analysis of medicare part d formulary trends, 20112015. This document includes a list of the drugs formulary for our plan, which is current as of october 19, 2017. Generic versions of advair, proair, and ventolin are now available on the formulary. Safer versions of opioids are on the formulary, including xtampza. If you are eligible to enroll under the special enrollment period and unable to mail your cms 40b, application for enrollment in medicare part b medical. Plans have a yearly limit on what you pay medicare authorization to disclose personal state medical assistance medicaid office 50, 66 the.
If you dont sign up for part b during your iep, you can sign up during the gep. Contact social security if you want to apply for form cmsl564. Nov 08, 2019 medicare and you handbook 2019 medicare. I have part a and want to apply for part b application for enrollment in part bcms40b. Providence medicare advantage plans has updated our formularies for 2020. If you are already in medicare part a you should apply for medicare part b by filing form cms 40b, which is actually application for enrollment in medicare part b medical insurance. If you sign up during a gep, your part b coverage begins july 1 of that year. Humana is also a coordinated care plan with a medicare contract and a contract with the state medicaid program.