Your Care.

Your Advantage.

PLAN PREMIUM

Medicare Advantage Plan

With Prescription Drug Coverage

(You must continue to pay your Part B premium)

(Part D coverage is provided at no additional premium to you)

(If you are a dual eligible, your Medicare Part B premium will be paid by the state on your behalf)

COPAY

  • Primary office care visits
  • Up to $60 a month OTC benefit
  • Routine transportation
  • All covered dental services
  • Routine eye exams
  • Up to $1,000 for hearing aids every three years
  • Up to $20,000 Emergency Worldwide Coverage
2014 Senior Gold Choice Award

Liberty Health Advantage

members continue to receive All their current Medicare benefits

PLUS MUCH MORE!

Limitations,co-payments and restrictions may apply.

Benefits, formulary, pharmacy network, premium and/or co-payments/co-insurance may change on January 1 of each year.

Liberty Health Advantage HMO is an HMO Plan with a Medicare Advantage contract and a contract with the New York State Medicaid program.

Enrollment in Liberty Health Advantage HMO depends on contract renewal.

If you would like to file an appeal or grievance for your medical benefit coverage, click on the following link to access our Liberty Health Advantage Grievance and Appeals - Medical

If you would like to file an appeal or grievance for your prescription drug coverage or to request a coverage determination for a drug, click on the following link to access our Liberty Health Advantage Grievance and Appeals - Part D

If you prefer to file a grievance through Medicare, click on the following link: Medicare Electronic Complaint Form

To check the status of your Appeal or Grievances, call Member Services at 866-542-4269



H3337 2014 Website Approved 01/03/2014

Last Modified: January 13, 2014 09:57:34