Frequently Asked Questions
What is Medicare Advantage?
Community First Medicare Advantage Plan is a comprehensive Medicare plan that covers Parts A, B, and includes D, your prescription benefit.
What is Medicare Advantage D-SNP?
D-SNP stands for Dual Eligible Special Needs and it includes individuals who are entitled to both Medicare and Medicaid coverage.
What is the difference between Medicare Advantage and Medicare Advantage D-SNP?
Medicare Advantage is comprehensive Medicare coverage for individuals but does not include other federally funded programs. Medicare Advantage DSNP is coverage for individuals that include both Medicare Advantage AND Medicaid.
What is a Medicare Beneficiary?
A Medicare Beneficiary is a person who has applied and been approved for Medicare benefits by the federal government.
How old do you need to be to receive Medicare benefits?
Medicare is the federally funded health insurance program for people who are:
- age 65 or older,
- certified as medically disabled by the Social Security Administration (SSA) or
- of any age with end-stage renal disease (ESRD) or Lou Gehrig’s disease.
What does Medicare cover?
Community First Medicare Advantage covers health care services such as:
- skilled nursing facilities, hospice, and home health care
- medical services like doctor visits and outpatient care
- some preventive services including screenings and vaccines
- some durable medical equipment like wheelchairs and walkers
- prescription drugs and over the counter medications
- Other medically necessary services
When should I enroll in Medicare?
You are eligible for Medicare when you turn 65. Generally, you should sign up for Medicare as soon as you are eligible.
How do I enroll in Medicare?
When is open enrollment for Medicare?
Open enrollment this year runs from October 15, 2020 to December 7, 2020.
Where can I find more detailed information on Medicare?
What kind of plan is Community First?
CFHP is an HMO Plan. You generally must get your care and services from providers in our network, except for:
- Emergency care
- Out-of-area urgent care
- Out-of-area dialysis
Are prescription drugs covered with CFHP?
Yes, most prescription drugs are covered by Community First. For drugs that are not covered, your primary care doctor can submit a request for coverage.
Do I need to choose a primary care doctor?
Yes, you need to choose a primary care doctor in the Community First provider network.
Do I need a referral or authorization to see a specialist?
Community First does not require a referral to see a specialist. Some specialist may require a referral from your PCP in order to see you. Additionally, some services require a pre-authorization from Community First before you receive services. Your PCP will take care of this request for you. Please see the Explanation of Coverage for your plan for more details.
When does my coverage begin?
Benefits begin on January 1, 2021 for Community First Medicare Members who enroll between October 15-December 7, 2020.
Can I have both Medicare and Medicaid at the same time?
Yes, visit Medicare.gov for details on how you can receive both Medicare and Medicaid benefits.
What else do I need to know about Community First HMO Medicare plan?
- If your doctor or other health care provider leaves the plan, your plan will notify you. You can choose another doctor in the plan.
- If you get health care outside of the Community First provider network, you may have to pay the full cost.
- It’s important that you follow our guidelines, such as getting prior approval for a certain service when needed. Your PCP can advise you when this is necessary, but you should always ask when told you need services such as surgeries.