Medicare Advantage FAQ
Frequently Asked Questions
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General Questions
Who is eligible for Quartz Medicare Advantage (HMO)?
Answer:
In order to be eligible for Quartz Medicare Advantage (HMO), you need to live in our service area. Also, in order to be eligible for any Medicare Advantage program, including Quartz Medicare Advantage, you must be eligible for Medicare Part A and enrolled in Medicare Part B.
What premium payment options do I have?
Answer:
Convenient ways to pay
As a Quartz Medicare member, you have several ways to pay your monthly premiums. The choice is yours.
By check, money order, bank account, or credit card. You can also pay through your MyChart account or over the phone with a credit card or bank account.
By auto-pay. This method will go into effect 30 days after we receive your autopay request.
Through Social Security. You can have your premium payment taken out of your Social Security check. Call a Quartz Champion to set this up.
For more details on how and where to pay, see your plan’s Evidence of Coverage.
What if I have a question regarding a claim?
Answer:
You may send a question through our secure member portal MyChart, or contact a Quartz Champion.
Is my routine doctor’s visit paid every 12 months or calendar year?
Answer:
Quartz Medicare Advantage members are eligible for one routine physical and vision exam every 12 months. If you have questions about the timing of your visit(s), please don’t hesitate to contact a Quartz Champion.
How do I find a doctor?
Answer:
Use our Find a Doctor tool, or refer to the provider directory. You can also contact a Quartz Champion for assistance.
How can I change my personal physician?
Answer:
You may change your personal physician through our secure member portal MyChart, or contact a Quartz Champion for assistance.
Am I covered when I am out of the service area?
Answer:
Aurora Health Care
Emergency or urgently needed care is covered anywhere in the world when you are traveling outside of the service area. For medications (Part D drugs), prescriptions must be obtained within the United States.
Gundersen Health System
Emergency or urgently needed care is covered anywhere in the world when you are traveling outside of the service area. For medications (Part D drugs), prescriptions must be obtained within the United States.
UW Health
Emergency or urgently needed care is covered anywhere in the world when you are traveling outside of the service area. For medications (Part D drugs), prescriptions must be obtained within the United States.
UW Health – Illinois
Emergency or urgently needed care is covered anywhere in the world when you are traveling outside of the service area.
How do I get a new ID card?
Answer:
You may request an ID card through MyChart or contact a Quartz Champion to have it mailed to you.
What rights and responsibilities do I have to the plan and upon disenrollment?
Answer:
Aurora Health Care
Please refer to your Evidence of Coverage to learn more about your rights and responsibilities.
EOC (see Chapter 6) | EOC for Plan with Part D (prescription coverage) (see Chapter 8)
Gundersen Health System
Please refer to your Evidence of Coverage (EOC) to learn more about your rights and responsibilities.
EOC (see Chapter 6) | EOC for Plan with Part D (prescription coverage) (see Chapter 8)
Gundersen Health System (Minnesota)
Please refer to your Evidence of Coverage (EOC) to learn more about your rights and responsibilities.
EOC (see Chapter 6) | EOC for Plan with Part D (prescription coverage) (see Chapter 8)
UW Health
Please refer to your Evidence of Coverage (EOC) to learn more about your rights and responsibilities.
EOC (see Chapter 6) | EOC for Plan with Part D (prescription coverage) (see Chapter 8)
UW Health – Illinois
Please refer to your Evidence of Coverage to learn more about your rights and responsibilities.
EOC (see Chapter 6) | EOC for Plan with Part D (prescription coverage) (see Chapter 8)
What is the difference between a General Authorization and a Durable Power of Attorney?
Answer:
A Durable Power of Attorney (DPOA) allows one individual to make decisions on behalf of another. A DPOA remains effective for life, unless it is revoked. There are two types of DPOA: one that applies to financial decisions and one that applies to health care decisions.
A General Authorization allows you to designate another individual to discuss your personal information. It does not allow the person to make decisions on your behalf. A General Authorization remains in effect for two years, unless revoked. You may also provide verbal consent to allow us to talk with another person you designate as your representative. However, your verbal consent is only valid on the day that it is given. If you would like to have another person continue to assist you, please submit a General Authorization Form to us.
Part D Prescription Drug Questions
What if I already have prescription drug coverage through Senior Care, the Veterans Administration, or a Retiree Plan?
Answer:
Anyone with current drug coverage through Senior Care, the Veterans Administration (VA), Tricare, or a Retiree Plan can choose a Medicare Advantage plan without Part D drug coverage and avoid penalties if their drug coverage is at least as good or better than Medicare Part D coverage. Please contact a Quartz Champion for details.
Are over-the-counter drugs covered?
Answer:
Over-the-counter (OTC) drugs are those that can be purchased without a prescription. Even with a prescription from your doctor, these drugs are not eligible for coverage with Quartz Medicare Advantage. In addition, the cost of OTC drugs is not applied to your yearly out-of-pocket maximums.
What is my prescription coverage if I’m out of the service area?
Answer:
Quartz Medicare Advantage Part D drug coverage is processed through a pharmacy benefit manager. The Quartz Medicare Advantage pharmacy benefit manager has contracts with over 55,000 pharmacies nationwide, which exceeds the Medicare access guidelines. Therefore, you will have coverage for prescription drugs outside of our service area as long as you choose a pharmacy contracted through the pharmacy benefit manager. You can contact us to locate a pharmacy or use our online Provider and Pharmacy Directory.
What are my prescription copays and coinsurance?
Answer:
The amount you pay for your medication(s) can be located in your Plan’s Summary of Benefits document.
What is a generic equivalent?
Answer:
A medication that contains identical amounts of the same active ingredient in the same dosage form and route of administration that is expected to have the same clinical effects and safety profile as another product, as designated by the United States Federal Food and Drug Administration (FDA).
Are generic drugs safe and effective?
Answer:
Yes, according to the Federal Food and Drug Administration (FDA), generic drugs are safe and effective. Generic medications must meet the same standards for purity, strength, and quality as brand name drugs. They must be approved by the FDA before they can be sold to consumers. Generics may look different from the brand name medication in color, shape, or size as required by the FDA.
What is the Prior Authorization medication list?
Answer:
To promote the most appropriate utilization, certain medications require an approval of a Prior Authorization (PA) by our Pharmacy Department. Upon enrollment or upon request, the member will receive a list of prior authorized prescription drugs. These medications are also identified on the Formulary with a (PA) after the drug name. Prior authorization criteria is established by our Pharmacy and Therapeutics Committee with input from plan physicians and consideration of the current medical literature. If a medication is required that is not routinely covered, the provider may present medical evidence to obtain an individual patient exception by submitting an exception request for review.
What can I do if my prescription drug requires Prior Authorization or is not covered?
Answer:
As a member of Quartz Medicare Advantage, you may initiate an exception request process.
What is a mail-order pharmacy?
Answer:
A mail-order pharmacy delivers medicines to your home through the mail. By using a mail-order pharmacy you can get up to a 90-day supply of medication, often at a lower copayment. Mail-order pharmacies deliver medicines in a confidential package. Many people prefer the convenience of this type of service. Quartz Medicare Advantage members are not required to use a mail-order pharmacy. However, if you are interested in using one, please contact a Quartz Champion. More details may be found here at Mail Service Pharmacy.
How do I request reimbursement for a prescription I paid for myself?
Answer:
When purchasing prescription medications, you are encouraged to use your Pharmacy Prescription Card. If for some reason you are unable to utilize your pharmacy card and are required by the pharmacy to pay for the medications, you may submit your itemized pharmacy receipt to us. Prescription medications purchased from a pharmacy will be reimbursed through our Pharmacy Benefits Management at our current discount contracted rates. Any difference between the discount contracted rate and what the provider has billed will be your responsibility.
Privacy Questions
What is HIPAA?
Answer:
The Health Insurance Portability and Accountability Act (HIPAA) of 1996 is a federal law that applies to both insurance companies and providers. HIPAA provides portability and continuity of health insurance coverage as well as protection of your personal health information.
What do I do if I believe that my privacy rights have been violated?
Answer:
If you have questions or concerns about the way Quartz Medicare Advantage has protected the privacy of your personal information, please contact the Privacy Specialist at (608) 881-8155.