Capital Health Plan Preferred Advantage (HMO) is a Medicare Advantage plan that is available to individuals who are entitled to Medicare Part A, enrolled in Medicare Part B, live in the Capital Health Plan service area, and do not have End Stage Renal Disease. Capital Health Plan Preferred Advantage will provide all of your Medicare benefits and services including prescription drug coverage (Medicare Parts A, B, and D). Review the Summary of Benefits, attend a seminar, or call our office to talk to one of our experienced representatives to find the plan that is right for you.
CHP Preferred Advantage (HMO)
The Annual Notice of Changes provides details of changes in plan benefits and coverage from one year to the next.
The 2019 CHP Advantage Plus and Preferred Advantage Summary of Benefits provides a summary of your plan’s benefits, premium, copayments, and coinsurance information.
A formulary is a list of covered drugs believed to be a necessary part of a quality treatment program. The 2019 CHP Advantage Plus and Preferred Advantage Formulary was selected by CHP in consultation with a team of health care providers. You can also use our online formulary search tool.
Your 2019 Preferred Advantage Evidence of Coverage (EOC) provides details about your Medicare health and prescription drug coverage, explains how to get the care you need, and includes plan conditions and limitations.
- Medication Therapy Management Program
- Prescription Drug Transition Process
Sometimes you are taking a drug that is not on our formulary, and if that is the circumstance please review the 2019 Prime Medicare Transition Policy for additional information. During the time when you are receiving a temporary supply of a drug, you should talk with your provider to decide what to do when your temporary supply runs out. You can either switch to a different drug covered by the plan or ask the plan to make an exception for you and cover your current drug. For a temporary supply, please call CHP Member Services.
- Part D Exceptions
- Pharmacy Search Tool
- Formulary Search Tool
Download and complete the 2019 CHP Advantage Plus and Preferred Advantage Enrollment Application. You can also download the Enrollment Checklist as a guide.
You may be able to get Extra Help to pay for your prescription drug premiums and costs. The amount of Extra Help that you can get depends on your income and resources. If you qualify, you will get help paying for your Medicare drug plan's monthly premium and prescription copayments or coinsurance. Your premium generally will be lower if you receive Extra Help from Medicare.
If you get Extra Help from Medicare for your Medicare prescription drug plan costs, your monthly plan premium will be reduced. The amount of Extra Help determines your total monthly plan premium. The Low Income Subsidy (LIS) Chart shows you what your monthly plan premium will be if you get Extra Help.
You can qualify if you are eligible for Medicaid as well as Medicare. You also may qualify if your yearly income is $18,735 or less if you are single with no dependents, or $25,365 or less if you are married and living with your spouse with no dependents, and your resources are less than $14,390 if single or $28,720 if you are married and living with your spouse. If you live in Alaska or Hawaii, or pay at least half of the living expenses of dependent family members, income limits are higher.
Documents on this page are available in Portable Document Format (PDF). Adobe Reader (free) may be used to open these files.
- Advanced Directives - Information on Advanced Directives including the Living Will and Health Care Surrogate
- Appointment of Representative Form - Assign someone to represent you in accordance with HIPAA regulations using an Appointment of Representative form.
- Appointment of Representative Form Instructions
- Authorization to Disclose Protected Health Information
- Communication Directive Form - Specify who can communicate with your health care team using the Communication Directive Form.
- Request for Medicare Prescription Drug Coverage Determination Form is for member and health care provider use.
- Request for Redetermination of Medicare Prescription Drug Denial Form
- Enrollment Application - 2019 Capital Health Plan Advantage Plus and Capital Health Plan Preferred Advantage.
- Health and Fitness Reimbursement Form
- Medicare Complaint Form - You are now able to submit feedback about your Medicare health plan or other non-urgent issues directly to Medicare using the Medicare Complaint Form.
- The Office of the Medicare Ombudsman - The Office of the Medicare Ombudsman (OMO) helps you with complaints, grievances, and information requests.
An advanced directive ensures that both medical professionals and your loved ones understand the end-of-life decisions you want in the event you’re unable to explain them due to a medical emergency. An advanced 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.
To obtain a copy of Five Wishes, an advanced directive document that addresses all of an individual's needs (medical, personal, emotional, and spiritual), call Capital Health Plan's Health Information Line at (850) 383-3400.
Through the Planning Early About Care at the End (PEACE) program, Big Bend Hospice offers individualized assistance in completing the Five Wishes Advanced Directive. To schedule an appointment with a PEACE facilitator, contact Big Bend Hospice at (850) 878-5310 or visit the Big Bend Hospice website.
- Medical Care & Services
- Prescription Drug Coverage
- Request for Medicare Prescription Drug Coverage Redetermination
- Download the Request for Medicare Prescription Drug Coverage Determination Form to request an exception.
- Download the Request for Redetermination of Medicare Prescription Drug Denial Form to request a redetermination.
- Appointment of Representative Form
- For instructions on how to use the form to appoint a representative, visit Appointment of Representative Form Instructions.
Privacy Notice - We believe our members have the right to privacy and that their nonpublic personal, financial, and health information should be kept confidential.
Capital Health Plan makes health care decisions to ensure quality treatment and efficient use of resources. View more information about utilization management.