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Chapter 2 - Important phone numbers and resources


Chapter 2 - Important phone numbers and resources



How to contact our plan’s Member Services

For assistance with claims, billing, or member card questions, please call or write to KelseyCare Advantage Rx+Choice Member Services. We will be happy to help you.



Method Member Services – Contact Information
CALL 1-866-535-8343
Calls to this number are free. From October 1 through March 31, hours are 8:00 a.m. to 8:00 p.m., seven days a week. During this period on Thanksgiving Day and Christmas Day, calls are handled by our voicemail system. From April 1 through September 30, hours are 8:00 a.m. to 8:00 p.m., Monday through Friday. During this period on Saturdays, Sundays, and holidays, calls are handled by our voicemail system.

Member Services also has free language interpreter services available for non-English speakers.
TTY 1-866-302-9336
This number requires special telephone equipment and is only for people who have difficulties with hearing or speaking.
Calls to this number are free. From October 1 through March 31, hours are 8:00 a.m. to 8:00 p.m., seven days a week. During this period on Thanksgiving Day and Christmas Day, calls are handled by our voicemail system. From April 1 through September 30, hours are 8:00 a.m. to 8:00 p.m., Monday through Friday. During this period on Saturdays, Sundays, and holidays, calls are handled by our voicemail system.
FAX 713-442-5450
WRITE KelseyCare Advantage
ATTN: Member Services
11511 Shadow Creek Parkway
Pearland, TX 77584
– OR –

PO Box 841569
Pearland, TX 77584-9832
WEBSITE www.kelseycareadvantage.com

How to contact us when you are asking for a coverage decision about your medical care

A coverage decision is a decision we make about your benefits and coverage or about the amount we will pay for your medical services. For more information on asking for coverage decisions about your medical care, see Chapter 9 (What to do if you have a problem or complaint (coverage decisions, appeals, complaints)).

You may call us if you have questions about our coverage decision process.

Method Coverage Decisions For Medical Care – Contact Information
CALL 1-866-535-8343
Calls to this number are free. From October 1 through March 31, hours are 8:00 a.m. to 8:00 p.m., seven days a week. During this period on Thanksgiving Day and Christmas Day, calls are handled by our voicemail system. From April 1 through September 30, hours are 8:00 a.m. to 8:00 p.m., Monday through Friday. During this period on Saturdays, Sundays, and holidays, calls are handled by our voicemail system.
TTY 1-866-302-9336

This number requires special telephone equipment and is only for people who have difficulties with hearing or speaking.

Calls to this number are free. From October 1 through March 31, hours are 8:00 a.m. to 8:00 p.m., seven days a week. During this period on Thanksgiving Day and Christmas Day, calls are handled by our voicemail system. From April 1 through September 30, hours are 8:00 a.m. to 8:00 p.m., Monday through Friday. During this period on Saturdays, Sundays, and holidays, calls are handled by our voicemail system.
FAX 713-442-5450
WRITE KelseyCare Advantage
ATTN: Member Services
11511 Shadow Creek Parkway
Pearland, TX 77584
– OR –

PO Box 841569
Pearland, TX 77584-9832
WEBSITE www.kelseycareadvantage.com

How to contact us when you are making an appeal about your medical care

An appeal is a formal way of asking us to review and change a coverage decision we have made. For more information on making an appeal about your medical care, see Chapter 9 (What to do if you have a problem or complaint (coverage decisions, appeals, complaints)).

Method Appeals For Medical Care – Contact Information
CALL 1-866-535-8343
Calls to this number are free. From October 1 through March 31, hours are 8:00 a.m. to 8:00 p.m., seven days a week. During this period on Thanksgiving Day and Christmas Day, calls are handled by our voicemail system. From April 1 through September 30, hours are 8:00 a.m. to 8:00 p.m., Monday through Friday. During this period on Saturdays, Sundays, and holidays, calls are handled by our voicemail system.
TTY 1-866-302-9336

This number requires special telephone equipment and is only for people who have difficulties with hearing or speaking.

Calls to this number are free. From October 1 through March 31, hours are 8:00 a.m. to 8:00 p.m., seven days a week. During this period on Thanksgiving Day and Christmas Day, calls are handled by our voicemail system. From April 1 through September 30, hours are 8:00 a.m. to 8:00 p.m., Monday through Friday. During this period on Saturdays, Sundays, and holidays, calls are handled by our voicemail system.
FAX 713-442-9536
WRITE KelseyCare Advantage
ATTN: Member Services
11511 Shadow Creek Parkway
Pearland, TX 77584
– OR –

PO Box 841569
Pearland, TX 77584-9832
WEBSITE www.kelseycareadvantage.com

How to contact us when you are making a complaint about your medical care

You can make a complaint about us or one of our network providers, including a complaint about the quality of your care. This type of complaint does not involve coverage or payment disputes. (If your problem is about the plan’s coverage or payment, you should look at the section above about making an appeal.) For more information on making a complaint about your medical care, see Chapter 9 (What to do if you have a problem or complaint (coverage decisions, appeals, complaints)).

Method Complaints About Medical Care – Contact Information
CALL 1-866-535-8343
Calls to this number are free. From October 1 through March 31, hours are 8:00 a.m. to 8:00 p.m., seven days a week. During this period on Thanksgiving Day and Christmas Day, calls are handled by our voicemail system. From April 1 through September 30, hours are 8:00 a.m. to 8:00 p.m., Monday through Friday. During this period on Saturdays, Sundays, and holidays, calls are handled by our voicemail system.
TTY 1-866-302-9336

This number requires special telephone equipment and is only for people who have difficulties with hearing or speaking.

Calls to this number are free. From October 1 through March 31, hours are 8:00 a.m. to 8:00 p.m., seven days a week. During this period on Thanksgiving Day and Christmas Day, calls are handled by our voicemail system. From April 1 through September 30, hours are 8:00 a.m. to 8:00 p.m., Monday through Friday. During this period on Saturdays, Sundays, and holidays, calls are handled by our voicemail system.
FAX 713-442-9536
WRITE KelseyCare Advantage
ATTN: Member Services
11511 Shadow Creek Parkway
Pearland, TX 77584
– OR –

PO Box 841569
Pearland, TX 77584-9832
MEDICARE WEBSITE You can submit a complaint about KelseyCare Advantage Rx+Choice directly to Medicare. To submit an online complaint to Medicare go to https://www.medicare.gov/MedicareComplaintForm/home.aspx.

How to contact us when you are asking for a coverage decision about your Part D prescription drugs

A coverage decision is a decision we make about your benefits and coverage or about the amount we will pay for your prescription drugs covered under the Part D benefit included in your plan. For more information on asking for coverage decisions about your Part D prescription drugs, see Chapter 9 (What to do if you have a problem or complaint (coverage decisions, appeals, complaints)).

Method Coverage Decisions for Part D Prescription Drugs – Contact Information
CALL 713-442-4810 or 1-844-541-8507

Calls to this number are free. Hours of operation are 8:00 a.m. to 8:00 p.m., Monday through Friday. During after hours, Saturdays, Sundays, and holidays, calls are handled by our voicemail system.
TTY 1-855-815-2061

This number requires special telephone equipment and is only for people who have difficulties with hearing or speaking.

Calls to this number are free. Hours of operation are 8:00 a.m. to 8:00 p.m., Monday through Friday.
FAX 713-442-4848 or 1-844-541-8508
WRITE KelseyCare Advantage
ATTN: Member Services
11511 Shadow Creek Parkway
Pearland, TX 77584
– OR –

PO Box 841569
Pearland, TX 77584-9832
WEBSITE www.kelseycareadvantage.com

How to contact us when you are making an appeal about your Part D prescription drugs

An appeal is a formal way of asking us to review and change a coverage decision we have made. For more information on making an appeal about your Part D prescription drugs, see Chapter 9 (What to do if you have a problem or complaint (coverage decisions, appeals, complaints)).

Method Appeals for Part D Prescription Drugs – Contact Information
CALL 1-866-535-8343
Calls to this number are free. From October 1 through March 31, hours are 8:00 a.m. to 8:00 p.m., seven days a week. During this period on Thanksgiving Day and Christmas Day, calls are handled by our voicemail system. From April 1 through September 30, hours are 8:00 a.m. to 8:00 p.m., Monday through Friday. During this period on Saturdays, Sundays, and holidays, calls are handled by our voicemail system.
TTY 1-866-302-9336

This number requires special telephone equipment and is only for people who have difficulties with hearing or speaking.

Calls to this number are free. From October 1 through March 31, hours are 8:00 a.m. to 8:00 p.m., seven days a week. During this period on Thanksgiving Day and Christmas Day, calls are handled by our voicemail system. From April 1 through September 30, hours are 8:00 a.m. to 8:00 p.m., Monday through Friday. During this period on Saturdays, Sundays, and holidays, calls are handled by our voicemail system.
FAX 713-442-9536
WRITE KelseyCare Advantage
ATTN: Member Services
11511 Shadow Creek Parkway
Pearland, TX 77584
– OR –

PO Box 841569
Pearland, TX 77584-9832
WEBSITE www.kelseycareadvantage.com.

How to contact us when you are making a complaint about your Part D prescription drugs

You can make a complaint about us or one of our network pharmacies, including a complaint about the quality of your care. This type of complaint does not involve coverage or payment disputes. (If your problem is about the plan’s coverage or payment, you should look at the section above about making an appeal.) For more information on making a complaint about your Part D prescription drugs, see Chapter 9 (What to do if you have a problem or complaint (coverage decisions, appeals, complaints)).

Method Complaints about Part D prescription drugs – Contact Information
CALL 1-866-535-8343

Calls to this number are free. From October 1 through March 31, hours are 8:00 a.m. to 8:00 p.m., seven days a week. During this period on Thanksgiving Day and Christmas Day, calls are handled by our voicemail system. From April 1 through September 30, hours are 8:00 a.m. to 8:00 p.m., Monday through Friday. During this period on Saturdays, Sundays, and holidays, calls are handled by our voicemail system.
TTY 1-866-302-9336

This number requires special telephone equipment and is only for people who have difficulties with hearing or speaking.

Calls to this number are free. From October 1 through March 31, hours are 8:00 a.m. to 8:00 p.m., seven days a week. During this period on Thanksgiving Day and Christmas Day, calls are handled by our voicemail system. From April 1 through September 30, hours are 8:00 a.m. to 8:00 p.m., Monday through Friday. During this period on Saturdays, Sundays, and holidays, calls are handled by our voicemail system.
FAX 713-442-9536
WRITE KelseyCare Advantage
ATTN: Member Services
11511 Shadow Creek Parkway
Pearland, TX 77584

– OR –

PO Box 841569
Pearland, TX 77584-9832
MEDICARE WEBSITE You can submit a complaint about KelseyCare Advantage Rx+Choice directly to Medicare. To submit an online complaint to Medicare go to https://www.medicare.gov/MedicareComplaintForm/home.aspx.

Where to send a request asking us to pay for our share of the cost for medical care or a drug you have received

For more information on situations in which you may need to ask us for reimbursement or to pay a bill you have received from a provider, see Chapter 7 (Asking us to pay our share of a bill you have received for covered medical services or drugs).

Please note: If you send us a payment request and we deny any part of your request, you can appeal our decision. See Chapter 9 (What to do if you have a problem or complaint (coverage decisions, appeals, complaints)) for more information.

Method Payment Requests – Contact Information
CALL Medical Claims - 1-866-535-8343

Calls to this number are free. From October 1 through March 31, hours are 8:00 a.m. to 8:00 p.m., seven days a week. During this period on Thanksgiving Day and Christmas Day, calls are handled by our voicemail system. From April 1 through September 30, hours are 8:00 a.m. to 8:00 p.m., Monday through Friday. During this period on Saturdays, Sundays, and holidays, calls are handled by our voicemail system.

Part D Drug Claims - 713-442-4810 or 1-844-541-8507

Calls to this number are free. Hours of operation are 8:00 a.m. to 8:00 p.m., Monday through Friday. During after hours, Saturdays, Sundays, and holidays, calls are handled by our voicemail system.
TTY Medical Claims - 1-866-302-9336

This number requires special telephone equipment and is only for people who have difficulties with hearing or speaking.

Calls to this number are free. From October 1 through March 31, hours are 8:00 a.m. to 8:00 p.m., seven days a week. During this period on Thanksgiving Day and Christmas Day, calls are handled by our voicemail system. From April 1 through September 30, hours are 8:00 a.m. to 8:00 p.m., Monday through Friday. During this period on Saturdays, Sundays, and holidays, calls are handled by our voicemail system.

Part D Drug Claims - 1-855-815-2061

This number requires special telephone equipment and is only for people who have difficulties with hearing or speaking.

Calls to this number are free. Hours of operation are 8:00 a.m. to 8:00 p.m., Monday through Friday.
FAX Medical Claims
713-442-5450
Part D Drug Claims
1-844-541-8508 or
713-442-4848
WRITE Medical Claims
KelseyCare Advantage
ATTN: Member Services
11511 Shadow Creek Parkway
Pearland, TX 77584

Part D Drug Claims
KelseyCare Advantage
ATTN: Pharmacy Services
11511 Shadow Creek Parkway
Pearland, TX 77584
– OR –

PO Box 841569
Pearland, TX 77584-9832




P.O. Box 841569
Pearland, TX 77584-9832
WEBSITE www.kelseycareadvantage.com.

Medicare is the Federal health insurance program for people 65 years of age or older, some people under age 65 with disabilities, and people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a kidney transplant).

The Federal agency in charge of Medicare is the Centers for Medicare & Medicaid Services (sometimes called "CMS"). This agency contracts with Medicare Advantage organizations including us.

Method Medicare – Contact Information
CALL 1-800-MEDICARE, or 1-800-633-4227
Calls to this number are free.
24 hours a day, 7 days a week.
TTY 1-877-486-2048
This number requires special telephone equipment and is only for people who have difficulties with hearing or speaking.
Calls to this number are free.
WEBSITE https://www.medicare.gov

This is the official government website for Medicare. It gives you up-to-date information about Medicare and current Medicare issues. It also has information about hospitals, nursing homes, physicians, home health agencies, and dialysis facilities. It includes booklets you can print directly from your computer. You can also find Medicare contacts in your state.

The Medicare website also has detailed information about your Medicare eligibility and enrollment options with the following tools:

  • Medicare Eligibility Tool: Provides Medicare eligibility status information.
  • Medicare Plan Finder: Provides personalized information about available Medicare prescription drug plans, Medicare health plans, and Medigap (Medicare Supplement Insurance) policies in your area. These tools provide an estimate of what your out-of-pocket costs might be in different Medicare plans.

You can also use the website to tell Medicare about any complaints you have about KelseyCare Advantage Rx+Choice:

  • Tell Medicare about your complaint: You can submit a complaint about KelseyCare Advantage Rx+Choice directly to Medicare. To submit a complaint to Medicare, go to https://www.medicare.gov/MedicareComplaintForm/home.aspx. Medicare takes your complaints seriously and will use this information to help improve the quality of the Medicare program.
If you don’t have a computer, your local library or senior center may be able to help you visit this website using its computer. Or, you can call Medicare and tell them what information you are looking for. They will find the information on the website, print it out, and send it to you. (You can call Medicare at 1-800-MEDICARE (1-800-633-4227), 24 hours a day, 7 days a week. TTY users should call 1-877-486-2048.)

The State Health Insurance Assistance Program (SHIP) is a government program with trained counselors in every state. In Texas, the SHIP is called the Health Information Counseling and Advocacy Program (HICAP) in partnership with the Texas Department of Health and Human Services.

Health Information Counseling and Advocacy Program (HICAP) is independent (not connected with any insurance company or health plan). It is a state program that gets money from the Federal government to give free local health insurance counseling to people with Medicare.

Health Information Counseling and Advocacy Program (HICAP) counselors can help you with your Medicare questions or problems. They can help you understand your Medicare rights, help you make complaints about your medical care or treatment, and help you straighten out problems with your Medicare bills. Health Information Counseling and Advocacy Program (HICAP) counselors can also help you understand your Medicare plan choices and answer questions about switching plans.


Method The Texas Department of Health and Human Services – Contact Information
CALL 1-800-252-9240 or 512-424-6500
TTY Texas Relay 1-800-735-2989
This number requires special telephone equipment and is only for people who have difficulties with hearing or speaking.
WRITE The Texas Department of Health and Human Services
P.O. Box 13247
Austin, TX 78711-3247
WEBSITE www.hhs.texas.gov

There is a designated Quality Improvement Organization for serving Medicare beneficiaries in each state. For Texas, the Quality Improvement Organization is called KEPRO.

KEPRO has a group of doctors and other health care professionals who are paid by the Federal government. This organization is paid by Medicare to check on and help improve the quality of care for people with Medicare. KEPRO is an independent organization. It is not connected with our plan.

You should contact KEPRO in any of these situations:

  • You have a complaint about the quality of care you have received.

  • You think coverage for your hospital stay is ending too soon.

  • You think coverage for your home health care, skilled nursing facility care, or Comprehensive Outpatient Rehabilitation Facility (CORF) services are ending too soon.

Method KEPRO, Texas’ Quality Improvement Organization – Contact Information
CALL 1-844-430-9504 to file a complaint or an appeal
Weekdays9:00 a.m. to 5:00 p.m. Weekends and Holidays:* 11:00 a.m. to 3:00 p.m.

*Representatives are not available on weekends and holidays to assist with quality of care concerns.
TTY 1-855-843-4776
This number requires special telephone equipment and is only for people who have difficulties with hearing or speaking.
WRITE KEPRO
5700 Lombardo Center Dr., Ste. 100
Seven Hills, OH 44131.
WEBSITE www.keproqio.com

Social Security is responsible for determining eligibility and handling enrollment for Medicare. U.S. citizens and lawful permanent residents who are 65 or older, or who have a disability or End-Stage Renal Disease and meet certain conditions, are eligible for Medicare. If you are already getting Social Security checks, enrollment into Medicare is automatic. If you are not getting Social Security checks, you have to enroll in Medicare. Social Security handles the enrollment process for Medicare. To apply for Medicare, you can call Social Security or visit your local Social Security office.

Social Security is also responsible for determining who has to pay an extra amount for their Part D drug coverage because they have a higher income. If you got a letter from Social Security telling you that you have to pay the extra amount and have questions about the amount or if your income went down because of a life-changing event, you can call Social Security to ask for reconsideration.

If you move or change your mailing address, it is important that you contact Social Security to let them know.


Method Social Security – Contact Information
CALL 1-800-772-1213
Calls to this number are free.
Available 7:00 am to 7:00 pm, Monday through Friday.
You can use Social Security’s automated telephone services to get recorded information and conduct some business 24 hours a day.
TTY 1-800-325-0778
This number requires special telephone equipment and is only for people who have difficulties with hearing or speaking.
Calls to this number are free.
Available 7:00 am to 7:00 pm, Monday through Friday.
WEBSITE https://www.ssa.gov

Medicaid is a joint Federal and state government program that helps with medical costs for certain people with limited incomes and resources. Some people with Medicare are also eligible for Medicaid.

In addition, there are programs offered through Medicaid that help people with Medicare pay their Medicare costs, such as their Medicare premiums. These "Medicare Savings Programs" help people with limited income and resources save money each year:

  • Qualified Medicare Beneficiary (QMB): Helps pay Medicare Part A and Part B premiums, and other cost-sharing (like deductibles, coinsurance, and copayments). (Some people with QMB are also eligible for full Medicaid benefits (QMB+).)
  • Specified Low-Income Medicare Beneficiary (SLMB): Helps pay Part B premiums. (Some people with SLMB are also eligible for full Medicaid benefits (SLMB+).)
  • Qualified Individual (QI): Helps pay Part B premiums.
  • Qualified Disabled & Working Individuals (QDWI): Helps pay Part A premiums.

To find out more about Medicaid and its programs, contact Texas Health and Human Services Commission (HHSC).


Method Texas Health and Human Services Commission (HHSC) – Contact Information
CALL 1-800-252-8263 or dial 2-1-1 in Texas

Monday through Friday 7:00 a.m. - 7:00 p.m.
TTY 1-800-735-2989
This number requires special telephone equipment and is only for people who have difficulties with hearing or speaking.
WRITE Texas Health and Human Services Commission
Brown-Heatly Building
4900 N. Lamar Boulevard
Austin, TX 78751-2316
WEBSITE www.yourtexasbenefits.com or www.hhsc.state.tx.us

Medicare’s "Extra Help" Program

Medicare provides "Extra Help" to pay prescription drug costs for people who have limited income and resources. Resources include your savings and stocks, but not your home or car. If you qualify, you get help paying for any Medicare drug plan’s monthly premium, yearly deductible, and prescription copayments. This "Extra Help" also counts toward your out-of-pocket costs.

People with limited income and resources may qualify for "Extra Help." Some people automatically qualify for "Extra Help" and don’t need to apply. Medicare mails a letter to people who automatically qualify for "Extra Help."

You may be able to get "Extra Help" to pay for your prescription drug premiums and costs. To see if you qualify for getting "Extra Help," call:

  • 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048, 24 hours a day/7 days a week;

  • The Social Security Office at 1-800-772-1213, between 7 am to 7 pm, Monday through Friday. TTY users should call 1-800-325-0778 (applications); or

  • Your State Medicaid Office (applications) (See Section 6 of this chapter for contact information).

If you believe you have qualified for "Extra Help" and you believe that you are paying an incorrect cost-sharing amount when you get your prescription at a pharmacy, our plan has established a process that allows you to either request assistance in obtaining evidence of your proper copayment level, or, if you already have the evidence, to provide this evidence to us.

  • The plan will accept Best Available Evidence of Extra Help at the pharmacy or through the Member Services department. You will have to present paperwork showing either Medicaid eligibility, such as a Medicaid card or other state paperwork showing Medicaid eligibility or a letter or paperwork from Social Security showing you have been qualified for Extra Help. If you have the needed paperwork, your drug copayments will be adjusted at the point of sale. Member Services will need copies of your paperwork to make a permanent adjustment to the copayment levels.

  • When we receive the evidence showing your copayment level, we will update our system so that you can pay the correct copayment when you get your next prescription at the pharmacy. If you overpay your copayment, we will reimburse you. Either we will forward a check to you in the amount of your overpayment or we will offset future copayments. If the pharmacy hasn’t collected a copayment from you and is carrying your copayment as a debt owed by you, we may make the payment directly to the pharmacy. If a state paid on your behalf, we may make payment directly to the state. Please contact Member Services if you have questions (phone numbers are printed on the back cover of this booklet).

Medicare Coverage Gap Discount Program

The Medicare Coverage Gap Discount Program provides manufacturer discounts on brand name drugs to Part D members who have reached the coverage gap and are not receiving "Extra Help." For brand name drugs, the 70% discount provided by manufacturers excludes any dispensing fee for costs in the gap. Members pay 25% of the negotiated price and a portion of the dispensing fee for brand name drugs.

If you reach the coverage gap, we will automatically apply the discount when your pharmacy bills you for your prescription and your Part D Explanation of Benefits (Part D EOB) will show any discount provided. Both the amount you pay and the amount discounted by the manufacturer count toward your out-of-pocket costs as if you had paid them and move you through the coverage gap. The amount paid by the plan (5%) does not count toward your out-of-pocket costs.

You also receive some coverage for generic drugs. If you reach the coverage gap, the plan pays 63% of the price for generic drugs and you pay the remaining 37% of the price. For generic drugs, the amount paid by the plan (63%) does not count toward your out-of-pocket costs. Only the amount you pay counts and moves you through the coverage gap. Also, the dispensing fee is included as part of the cost of the drug.

The Medicare Coverage Gap Discount Program is available nationwide. Because KelseyCare Advantage Rx+Choice offers additional gap coverage during the Coverage Gap Stage, your out-of-pocket costs will sometimes be lower than the costs described here. Please go to Chapter 6, Section 6 for more information about your coverage during the Coverage Gap Stage.

If you have any questions about the availability of discounts for the drugs you are taking or about the Medicare Coverage Gap Discount Program in general, please contact Member Services (phone numbers are printed on the back cover of this booklet).

What if you have coverage from a State Pharmaceutical Assistance Program (SPAP)?

If you are enrolled in a State Pharmaceutical Assistance Program (SPAP), or any other program that provides coverage for Part D drugs (other than "Extra Help"), you still get the 70% discount on covered brand name drugs. Also, the plan pays 5% of the costs of brand drugs in the coverage gap. The 70% discount and the 5% paid by the plan are both applied to the price of the drug before any SPAP or other coverage.

What if you have coverage from an AIDS Drug Assistance Program (ADAP)? What is the AIDS Drug Assistance Program (ADAP)?

The AIDS Drug Assistance Program (ADAP) helps ADAP-eligible individuals living with HIV/AIDS have access to life-saving HIV medications. Medicare Part D prescription drugs that are also covered by ADAP qualify for prescription cost-sharing assistance from the Texas HIV Medication Program. Note: To be eligible for the ADAP operating in your State, individuals must meet certain criteria, including proof of State residence and HIV status, low income as defined by the State, and uninsured/under-insured status.

If you are currently enrolled in an ADAP, it can continue to provide you with Medicare Part D prescription cost-sharing assistance for drugs on the ADAP formulary. In order to be sure you continue receiving this assistance, please notify your local ADAP enrollment worker of any changes in your Medicare Part D plan name or policy number. (Texas HIV Medication Program, P.O. Box 149347, MC 1873, Austin, TX 78714).

For information on eligibility criteria, covered drugs, or how to enroll in the program, please call the Texas HIV Medication Program at 1-800-255-1090.

What if you get "Extra Help" from Medicare to help pay your prescription drug costs? Can you get the discounts?

No. If you get "Extra Help," you already get coverage for your prescription drug costs during the coverage gap.

What if you don’t get a discount, and you think you should have?

If you think that you have reached the coverage gap and did not get a discount when you paid for your brand name drug, you should review your next Part D Explanation of Benefits (Part D EOB) notice. If the discount doesn’t appear on your Part D Explanation of Benefits, you should contact us to make sure that your prescription records are correct and up-to-date. If we don’t agree that you are owed a discount, you can appeal. You can get help filing an appeal from your State Health Insurance Assistance Program (SHIP) (telephone numbers are in Section 3 of this Chapter) or by calling 1-800-MEDICARE (1-800-633-4227), 24 hours a day, 7 days a week. TTY users should call 1-877-486-2048.

State Pharmaceutical Assistance Programs

Many states have State Pharmaceutical Assistance Programs that help some people pay for prescription drugs based on financial need, age, medical condition, or disabilities. Each state has different rules to provide drug coverage to its members.

In Texas, the State Pharmaceutical Assistance Programs are the Texas Kidney Health Care Program and Texas HIV Medication Program.

Method Texas Kidney Health Care Program and Texas HIV Medication Program – Contact Information
CALL 1-800-222-3986 for Texas Kidney Health Care Program: Monday through Friday, 8:00 a.m. - 5:00 p.m. CST.
1-800-255-1090 for Texas HIV Medication Program: Monday through Friday, 8:00 a.m. - 5:00 p.m. CST.
TTY Texas Relay 1-800-735-2989

This number requires special telephone equipment and is only for people who have difficulties with hearing or speaking.
WRITE Kidney Health Care
BSpecialty Health Care Services, MC 1938
P.O. Box 149347
Austin, TX 78714-9347

DSHS HIV/STD Program
P.O. Box 149347, MC 1873
Austin, TX 78714
WEBSITE Texas Kidney Health Care Program
www.dshs.texas.gov/kidney/

Texas HIV Medication Program
www.dshs.state.tx.us/hivstd/meds/

The Railroad Retirement Board is an independent Federal agency that administers comprehensive benefit programs for the nation’s railroad workers and their families. If you have questions regarding your benefits from the Railroad Retirement Board, contact the agency.

If you receive your Medicare through the Railroad Retirement Board, it is important that you let them know if you move or change your mailing address.

Method Railroad Retirement Board – Contact Information
CALL 1-877-772-5772
Calls to this number are free.
Available 9:00 am to 3:30 pm, Monday through Friday.
If you have a touch-tone telephone, recorded information and automated services are available 24 hours a day, including weekends and holidays.
TTY 1-312-751-4701
This number requires special telephone equipment and is only for people who have difficulties with hearing or speaking.
Calls to this number are not free.
WEBSITE https://secure.rrb.gov/

If you (or your spouse) get benefits from your (or your spouse’s) employer or retiree group as part of this plan, you may call the employer/union benefits administrator or Member Services if you have any questions. You can ask about your (or your spouse’s) employer or retiree health benefits, premiums, or the enrollment period. (Phone numbers for Member Services are printed on the back cover of this booklet.) You may also call 1-800-MEDICARE (1-800-633-4227; TTY: 1-877-486-2048) with questions related to your Medicare coverage under this plan.

If you have other prescription drug coverage through your (or your spouse’s) employer or retiree group, please contact that group’s benefits administrator. The benefits administrator can help you determine how your current prescription drug coverage will work with our plan.