Aging Into Medicare
Retirement is a time to focus on yourself and enjoy all the leisure activities you have been dreaming of during your working years. Whether it’s sailing or boating on the Gulf, traveling the world, or spending your days on the golf course, retirement means no more work and ample “you time.” However, no longer working can also mean no more employer-provided healthcare coverage. That is why you will need to find the Medicare plan that is right for you.
Capital Health Plan is there for you every step of the way. To make the Medicare selection and enrollment process as simple as possible, we have created a guide that breaks down what aging into Medicare means and includes everything you need to know about Medicare coverage — so you can spend more time enjoying your retirement!
Get Started with Medicare
Medicare is health coverage provided by age or disability through the United States government. Medicare coverage is 80% and pays for hospital and doctor visits, physical and occupational therapy, and some home health services. Medicare does not cover long-term care, dental and vision, dentures, or hearing aids.
Medicare services are offered in four parts — Parts A, B, C, and D. Part A and Part B are known as “Original Medicare.”
- Part A. This includes hospital and doctor care. You can choose any doctor or hospital you want, as long as they accept Medicare payments.
- Part B. This part includes preventative care like wellness visits, flu shots, mammograms, cancer screenings, and laboratory tests. Part B also covers some medical equipment like wheelchairs and walkers.
- Part C. This is known as “Medicare Advantage” and is healthcare coverage run by private companies that have a contract with Medicare to provide Part A and Part B services. These companies usually offer extras not covered by Original Medicare, like hearing and vision coverage. If you have Part C Medicare coverage, you typically have to stay in-network and use the providers approved by the plan. There is a lot of variation in Part C and one should conduct ample research to find the right plan.
- Part D. This consists of prescription drug benefits. With Original Medicare, you need to join a drug plan (run by a private company) and pay a monthly premium. With Medicare Advantage, drug coverage may be part of your plan. Again, this varies, and one should conduct ample research to find the right program.
If you currently receive retirement benefits from Social Security or the Railroad Retirement Board, you are automatically enrolled in Part A and B, this coverage starts the first day of the month you turn 65. This means you will receive your Medicare card three months before your 65th birthday and that you do not have to sign up for Medicare coverage manually.
If you are not currently receiving Social Security or Railroad Retirement Board benefits, you must apply for Medicare coverage on your own. This scenario usually applies to people 65 or older who are still working. For those not automatically enrolled in Medicare, it’s crucial to note that you must sign up for Parts A and B. That coverage must start on the first day of the month you turn 65. If you sign up any later, you may have to pay a higher premium for the rest of your life.
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Capital Health Plan's Medicare Plans
Capital Health Plan offers five different Medicare plans. Explore our Medicare plans to find the right health coverage that best fits your needs.
If you’re new to Medicare or unsure where to begin, check out our Medicare Made Easy guide.
Attend a Medicare In-Person Seminar or Webinar
Understanding Medicare can be challenging. To receive more personalized help and speak to Medicare experts, Capital Health Plan offers events like in-person seminars and online webinars to discuss our Medicare Advantage (HMO) plans in detail and notify Medicare eligible individuals about available CHP health care services and programs.
Once you enroll in a plan, the information below will help you navigate what to do before and after your Medicare Advantage (HMO) plan starts.
I’ve Enrolled in a Medicare Plan, Now What
First, we thank you for choosing Capital Health Plan (CHP) as your Medicare Advantage plan. Your coverage is typically effective on the first day of the month after CHP receives your completed and signed enrollment form. We will send you a letter confirming your health plan coverage after the Centers for Medicare and Medicaid Services, also known as CMS, approves your enrollment. Additionally, you will receive a packet from CHP outlining the services available to you and how to manage your care.
The online tools and resources available on our website make it easy to find the benefits and services associated with each plan that we offer. As a CHP member you will have access to a large and stable network of local doctors and providers, plus exclusive access to three convenient, member-only health centers.
You can expect an invitation to attend a new member orientation seminar where we will discuss continued next steps for you. This orientation includes helping you select a primary care physician, an overview of your benefits and copayments, a high-level overview of your prescription drug coverage and additional services we provide to our members.
Please be aware that coverage typically takes effect on the first day of the month after CHP receives a completed enrollment application – whether online, by mail, or in person. After your enrollment is approved by the Centers for Medicare and Medicaid Service (CMS), we will send you a letter confirming your health plan coverage. You’ll also receive a packet from CHP outlining the services available to you and how to manage your care.
Before Your Medicare Plan Starts
It’s our pleasure to welcome you to Capital Health Plan Medicare Advantage (HMO). As a CHP member, you can review important Medicare benefit documents prior to your plan starting – right from the comfort of your own home.
Before Your Health Plan ID Card Arrives
- Find an in-network CHP Primary Care Physician
A primary care physician (PCP), sometimes called a primary care provider or doctor, can be a family practitioner, internal medicine doctor, or general medicine physician. Your PCP generally:- Knows or gets to know your medical history
- Builds an in-depth knowledge of your health over time
- Helps guide you on the best path of care
- Can advise you when to see a specialist and provide prior authorizations or referrals
Use our CHP Provider Directory or call us for help finding an in-network Primary Care Physician (PCP). You can also select a dedicated CHP PCP at one of CHP’s three member-exclusive health centers or enroll as a new patient at the Nancy Van Vessem, M.D., Center for Healthy Aging.
- Set An Appointment
Use the CHP Doctor/Facility Directory to see which physicians, specialists, hospitals, and clinics are in the network. Plan ahead by scheduling an appointment with your PCP, remember to make your first appointment date after the start of your coverage takes effect. Many preventive screenings and immunizations are covered at no cost to you when you see in-network CHP doctors/providers. - Complete an advance directive
An advance directive ensures that both medical professionals and your loved ones understand your end-of-life wishes should you be unable to explain them yourself due to a medical emergency. An advance directive is simply a statement, made while you are competent, about the medical treatment you want if you can’t make those decisions later. Decisions made early and communicated plainly may have tremendous value for you and your family amid the unexpected. CHP’s advance directive of choice is Five Wishes. To obtain a hard copy of Five Wishes, call CHP’s Health Information Line at 850-383-3400 or download your copy.
When Your Medicare Plan Begins
Thank you for being a member of Capital Health Plan. We’re here to help make each step of your health care experience easier. Review the information below to help you better understand your Medicare benefits, find care, manage costs, and get more out of your Medicare health plan.
When Your Health Plan ID Card Arrives
Keep up on preventive care
CHP Medicare Advantage plans cover preventive care – such as routine wellness exams, certain recommended screenings, and immunizations – at no additional cost to you when you see network doctor or providers.
Discover Simple Ways to Save
Stay in the CHP network
The doctors and facilities within the CHP network have agreed to provide service at a discount – so staying in the network makes sense, especially when a visit to an out-of-network doctor or provider could end up costing you a lot more for care. Find in-network doctors, pharmacies, hospitals, labs, mental health professionals, and more through our provider/facility directory.
Explore your pharmacy benefits
CHP Medicare members also have access to pharmacy benefits and services inclusive of a nationwide pharmacy network, mail-order pharmacies, home infusion pharmacies, and long-term care pharmacies.
Look up drug costs in our medication formulary
Learn more about your medication coverage by viewing the Medicare Formulary. The Formulary can also show if your medications include any requirements that must be met first, like prior authorization or step therapy.
To see how much your medications will cost you, find information on your medications, or discover lower-cost options, search for them with our online medication tool.
Obtain the Care You Need for Specific Conditions
Get emotional support
Your behavioral health benefit provides access to a network of nearby doctors and providers with options for either in-person care or a virtual visit. Get started by viewing in-network mental health professionals.
Treat chronic conditions
Capital Health Plan’s Center for Healthy Aging provides a comprehensive approach to the medical care of our members with chronic conditions – such as diabetes, heart failure, or coronary artery disease. Our internal medicine physicians support you with the physical, social, and emotional aspects of chronic illness to help you achieve better outcomes.
Receive free case management
To enroll in this free service, please call our Medicare Member Services team at (850) 523-7441, available October 1 – March 31, 8:00 a.m. – 8:00 p.m., seven days a week; and April 1 – September 30, 8:00 a.m. – 8:00 p.m., Monday – Friday. State of Florida Members can call 1 (877) 392-1532, 7:00 a.m. – 7:00 p.m., Monday – Friday.
One to Three Months Into Your Medicare Plan
Now that your Medicare plan benefits have started, you may have questions as you begin to coordinate doctors visits, fill prescriptions, understand your claims, and more.
We’re here for you, every step of the way.
With your new plan taking effect, you may wish to receive a refresher on your benefits either virtually or in person. Our Medicare Sales Team holds monthly seminars to review plan benefits, prescription drug coverage, and services offered within the plan. View CHP’s calendar of events for dates and times for specific plan seminars.
If you need assistance, please call our Medicare Member Services team at (850) 523-7441, October 1 – March 31, 8:00 a.m. – 8:00 p.m., seven days a week; and April 1 – September 30, 8:00 a.m. – 8:00 p.m., Monday – Friday. State of Florida Members can call 1 (877) 392-1532, 7:00 a.m. – 7:00 p.m., Monday – Friday.
Find Your Path to Better Health
Take Classes with You in Mind
CHP has partnered with the Tallahassee Senior Center to offer FREE Mindful Movement classes on the Senior Center’s Facebook page. In addition, classes will also air on Channel 13 (WCOT) at various times and days. Visit the Tallahassee Senior Center for more information.
In addition, we host other classes that range from reviewing your benefits, new member orientation, and so much more. To see upcoming topics, speakers, dates, and times, view our event calendar.
Keep Up with Your Fitness, Health & Wellness Reimbursement Benefits
Reward yourself for working hard on your health
CHP members can each receive up to $150 reimbursement per calendar year to put toward health and fitness expenses. Find a Wellness Reimbursement Form here.
All Medicare Advantage (HMO) members can be reimbursed for up to $150 for eyeglasses, including lenses and frames, or contact lenses every two years, based on the date of service. Consult your Evidence of Coverage for more information.
We are thrilled to welcome you as a new member. Capital Health Plan is here to help guide you through what matters most to you. If you would like to speak with a local CHP Medicare representative, please contact our Medicare Member Services team at (850) 523-7441, available October 1 – March 31, 8:00 a.m. – 8:00 p.m., seven days a week; and April 1 – September 30, 8:00 a.m. – 8:00 p.m., Monday – Friday. State of Florida Members can call 1 (877) 392-1532, 7:00 a.m. – 7:00 p.m., Monday – Friday.
Capital Health Plan Silver Advantage (HMO), Advantage Plus (HMO), Preferred Advantage (HMO), and Retiree Advantage (HMO) are HMO plans with a Medicare contract. Enrollment in Capital Health Plan Silver Advantage, Advantage Plus, Preferred Advantage, and Retiree Advantage depends on contract renewal. This information is not a complete description of benefits. Contact the plan for more information. Limitations, copayments, and restrictions may apply. Benefits, premiums, and/or copayments/coinsurance may change on January 1 of each year. The formulary, pharmacy network, and/or provider network may change at any time. You will receive notice when necessary.
If you have questions, please call Member Services at (850) 523-7441 or 1 (877) 247-6512 8:00 a.m. – 8:00 p.m., seven days a week, October 1 – March 31; 8:00 a.m. – 8:00 p.m., Monday – Friday, April 1 – September 30. State of Florida members call 1 (877) 392-1532, 7:00 a.m. – 7:00 p.m. TTY/TTD (850) 383-3534 or 1 (877) 870-8943.