CHP Retiree Advantage (HMO) State of Florida
Capital Health Plan Retiree Advantage (HMO) and Capital Health Plan Retiree Classic (HMO) are retiree plans offered by the State of Florida to Medicare-eligible retirees and their Medicare-eligible dependents. This provides our members the opportunity to participate in their State of Florida-sponsored health plan after retirement and becoming Medicare eligible. These plans provide access to an expansive network of physicians, including exclusive access to the Physician Group of Capital Health Plan located at one of our three health centers.
To be eligible for either plan option, you must be entitled to Medicare Part A, enrolled in Medicare Part B, and live in the Capital Health Plan service area. Retiree Advantage (HMO) and Retiree Classic (HMO) plans will provide all of your Medicare benefits and services, including prescription drug coverage (Medicare Parts A, B, and D). Review our calendar to attend a Medicare seminar, or call our local office to talk to one of our experienced representatives to learn more.
The Annual Notice of Changes provides details of changes in the Medicare Advantage plan benefits and coverage from one year to the next.
The Retiree Advantage Summary of Benefits provides a summary of your plan’s benefits, premium, copayments, and coinsurance information.
Review a list of covered drugs in our Medicare prescription formulary believed to be a necessary part of a quality treatment program. The CHP Retiree 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 2024 Retiree 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.
Capital Health Plan has a large network of doctors, facilities, and pharmacies. CHP members can explore our in-network providers and facilities.
Sometimes you are taking a drug that is not on our formulary, and if that is the circumstance please review the 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.
Medicare Enrollment
To enroll in CHP State of Florida Retiree Advantage Medicare plan, you will need to download and complete the 2024 CHP Retiree Advantage Enrollment Application. Please return the completed enrollment application directly to CHP. You may enroll anytime within 90 days before the effective date of coverage.
Extra Help & LIS Chart
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 $21,870 or less if you are single with no dependents, or $29,580 or less if you are married and living with your spouse with no dependents, and your resources are less than $16,660 if single or $33,240 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.
Forms
Medicare members can find and use the following forms to make requests to CHP regarding prescriptions, sharing of health information, reimbursements, and appointing a representative.
Request for Redetermination of Medicare Prescription Drug Denial
Request For Medicare Prescription Drug Coverage Determination
Additional Medicare Member Resources
View additional resources for medicare members inclusive of forms to appoint a representative, how to establish an advanced directive and living will, how to file a complaint, review our member privacy rights notice, and so much more.
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.