2017 Liberty Preferred Choice Plan (HMO)

Liberty Health Advantage HMO offers two Medicare Advantage Plans, one for beneficiaries with Medicare and one for beneficiaries with Medicare and Medicaid. Both plans include Part D prescription drug coverage.

To enroll in the Liberty Health Advantage Preferred Choice plan, you must have active Medicare Parts A & B, and continue to pay your Part B premium, and you must live in the service area.

CMS Medicare Website

Part C

Medicare Advantage (Medicare Part C) Information

Annual Notice of Changes for 2017

Aviso Anual de Cambios para 2017

Summary of Benefits

Resumen de Prestaciones

Evidence of Coverage

Evidencia de Cobertura

Multi-language Interpreter Services

Low Income Premiums

LIS Premiums

Search Options 2017

Best Available Evidence

Notices 2017

Rights & Responsibilities Help with Low Income Subsidy (LIS) Privacy Statement Potential Termination of Contract Ending your Membership Grievance and Appeals - Medical Presentación de quejas de y solicitudes ds las prestaciones - Medico Medicare Plan Rating - Plan performance Star Ratings are assessed each year and may change from one year to the next. Last updated 10/17/2016. Calificaciones del Plan Medicare - Plan de Clasificación por estrellas desempeño se evalúan cada año y pueden cambiar de un año al siguiente. Ultima actualización: 17/10/2016. Medicare Ombudsman Medicare Complaint Form


LogistiCare Transportation Brochure Folleto LogistiCare Transportación
Part D

Prescription Drug (Medicare Part D) Information

Liberty Health Advantage (LHA)

Provides the following useful tools in aiding our members to locate participating pharmacies and a formulary look up.

Liberty Health Advantage has contracts with over 2,592 pharmacies that meet or exceed CMS requirements for pharmacy access in your area.


Prescription Drug Reimbursement Form Instructions for requesting a redetermination Request for Medicare Prescription Drug Coverage Determination Solicitud Para La Determinación De Cobertura De Medicamentos Recetados De Medicare Vaccine Reimbursement Form How to Appoint a Representative Designación de Representante Appointment of Representative Medicare Prescription Drug Determination Request Form (Members) Medicare Prescription Drug Determination Request Form (Providers) Mail Order Brochure Folleto Electrónico Orden

Grievance and Appeals-Prescription Drugs

Summary of Part D plan grievance, coverage determination and appeals process. Resumen del procedimiento para la presentación de quejas y solicitudes Prestaciones para medicamentos de Parte D

To obtain an aggregate number of Appeals, Grievance & Exceptions filed with LHA, please contact Member Services.


General Transition Policy Medication Therapy Management Program (MTMP) Medication Therapy Management Program Personal Medication List Lista Personal De Medicamentos Step Therapy FAQ's Problem Solving plan for Step Therapy Drug Utilization Management Quantity Limits Step Therapy Protocol Prior Authorization Out of Network Provision

Pharmacy Directory

Liberty Health Advantage Pharmacy Search

Formulary Changes

Formulary Changes

Formulary Searches

Liberty Health Advantage Formulary

Pharmacy Copayments

Pharmacy Copayments Copagos de farmacia

OTC Benefits

OTC Catalog OTC Order Form OTC Formulario de pedido

Contact Information

Member and Provider Services

Sales Representative

Hours: 8:00AM to 8:00PM
Monday through Sunday

From February 15th through September 30th, hours are Monday - Friday only


Download an Enrollment Form

You may download, complete, sign and date an enrollment form. Application Instructions

Once you have completed the form please fax it to:


Or mail it to:

Liberty Health Advantage
1 Huntington Quadrangle
Suite 3N01
Melville, NY 11747

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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.

H3337 2017 Website Pending

Last Modified: Mon, June 26, 2017 14:29:56