Find answers to the most commonly asked Medicare questions

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Understanding my coverage and benefits

What is a network?

A network is a group of doctors, hospitals, pharmacies, and other medical service providers associated with your unique health plan.


What is a plan medical group (PMG)?

A plan medical group (PMG) is a designated group of physicians and hospitals associated with your network. You have access to hospitals, specialty care and urgent care centers affiliated with your PMG. It is important to keep in mind that referrals or authorizations do not transfer between PMGs, and you only have access to one PMG at a time.

With the Sharp Direct Advantage Network, you’ll find a family of providers close to where you live and spend time. Our network includes Sharp Rees-Stealy Medical Group (SRS), Sharp Community Medical Group (SCMG) and our regional partner, Greater Tri Cities Medical Group. To find out which doctors are affiliated with your PMG, refer to the Sharp Direct Advantage Network provider directory at sharpmedicareadvantage.com/findadoctor or call Customer Care at 1-855-562-8853 (TTY 711).


Accessing care

How do I get started with Silver&Fit?

Getting started with Silver&Fit is easy. We’ve made it simple with just three steps:
 
1. Visit SilverandFit.com online to find a participating Silver&Fit fitness center near you.
All you need to do is choose the type of fitness center you’d like to join, and type in your 
ZIP code or city. Then click Search to find the right gym for you.

2. Contact Silver&Fit to let them know which participating fitness center you’d like to join.
You can call the Silver&Fit toll-free Customer Services hotline at 1-877-427-4788 (TTY/TDD 1-877-710-2746). Your effective date, or the date you can start using your fitness center’s facilities for free, will be the day after you call to enroll.

3. Silver&Fit will send you a fitness card to bring when you show up to the fitness center of your choice.

If you’re not able to travel to a facility or prefer exercising at home, your benefits include a free at-home fitness option. Silver&Fit offers a Home Fitness Program, where you can choose up to two Home Fitness Kits per benefit year. Each kit has a fitness theme, and will include materials such as DVDs, booklets and a quick start guide. You can enroll online or by phone, using the customer services hotline above. To learn more about Silver&Fit, please visit their website at SilverandFit.com.


The gym I’m trying to enroll in can’t verify my eligibility. What do I do?

If your local Silver&Fit facility can’t find you in their system, please call Silver&Fit toll-free Customer Services hotline at 1-877-427-4788 (TTY/TDD 1-877-710-2746). They are available to assist you Monday – Friday 5 a.m. to 6 p.m., Pacific Time. If they are unable to find you in their system, please call Sharp Health Plan Customer Care at 1-855-562-8853 (TTY 711) to report this issue. Please be sure to have your Sharp Health Plan member ID number available.


Will I get a card for my Vision Service Plan (VSP)?

No. When you access vision care, your VSP provider can verify your coverage using your Sharp Health Plan member ID number (starts with the letter S).


My eye doctor is unable to verify my eligibility. What do I do?

If your Vision Service Plan (VSP) provider can’t find you in their system, please contact VSP Member Services at 1-800-877-7195, or send an email to imember@vsp.com to verify that you are in their system. They are available to assist you Monday – Friday, 5 a.m. to 8 p.m., Saturdays 7 a.m. to 8 p.m., and Sundays 7 a.m. to 7 p.m. Pacific Time. If they are unable to find you in their system, please call Sharp Health Plan Customer Care at 1-855-562-8853 (TTY 711) to report this issue. Please be sure to have your Sharp Health Plan member ID number available.


My dentist can’t verify my eligibility. What do I do?

If your dental provider can’t find you in their system, please call Delta Dental’s Customer Service Department at 1-800-390-3368 (TTY/TDD 711). They are available to assist you Monday – Friday, 5 a.m. to 5 p.m., Pacific Time. If they are unable to find you in their system, please call Sharp Health Plan Customer Care at 1-855-562-8853 (TTY 711) to report this issue. Please be sure to have your Sharp Health Plan member ID number available.


Is the Assist America phone number on my Sharp Direct Advantage member ID card?

No. Assist America’s contact information is not shown on your member ID Card. To contact Assist America in the U.S., please call 1-800-872-1414. To contact Assist America outside of the U.S., please call 1-609-986-1234. They are available to assist you 24 hours a day, seven days a week. Please be sure to have your Sharp Health Plan member ID number available.


Filling prescriptions

How do I sign up for mail-order prescriptions?

To sign up for mail-order prescriptions, please visit sharpmedicareadvantage.com/mailorder. You can also call Postal Prescription Services at 1-800-552-6694. They are available to assist Monday – Friday 6 a.m. to 6 p.m., and Saturdays 9 a.m. to 2 p.m., Pacific Time.

*Please note that Tier 5 medications are not available through mail order.

 


Selecting or changing my primary care physician

How do I choose a primary care physician (PCP)?

Your personal doctor, or primary care physician (PCP), is your partner in health. Whether it’s your first visit or an annual preventive care check-up, they will coordinate all of your care. They also provide referrals to other plan providers within your plan medical group. When you select a PCP, you are selecting your plan medical group. We encourage you to select a PCP who best suits your needs. If you are unable to select a PCP at the time you enroll in Sharp Health Plan, we will select one for you based on your mailing address, so that you can access care immediately.


Can I change my primary care physician (PCP)?

We know choosing the right PCP is a personal decision, which is why we make it easy for you to change your selection at any time. You can find a list of doctors online at sharpmedicareadvantage.com/findadoctor. If you wish to make a change, you can log in to Sharp Connect to use the online change PCP form, or call Customer Care at 1-855-562-8853 (TTY 711) and we will help you select a new PCP. The change will be effective on the first day of the following month. Upon making your selection, we will mail you a new member ID card.


Accessing plan materials and correspondence

Is there a way to decrease the amount of mail I receive from Sharp Health Plan? Can I elect for email notifications instead?

Unfortunately, no. Sharp Health Plan is required by the Centers for Medicare & Medicaid Services (CMS) to communicate most plan information to members by mail. For this same reason, we are unable to offer an email notification option for member correspondence at this time.


Registering for the portal

What is Sharp Connect?

Sharp Connect is our free online member portal that connects you with important plan information 24-hours a day. It’s mobile friendly, and allows you to view your benefits, update plan information, change your primary care physician, request a new member ID card, print a temporary card, check the covered drug list and much more.


I have a Sharp Connect account, why do I have to re-register?

We’re excited to announce a  portal upgrade that will offer even better functionality for our members online. As a result, we’re asking existing portal users to re-register on the portal for a brand new experience. You can do that by visiting the Sharp Medicare Advantage login page beginning January 1, 2018.


Applying for coverage

When can I apply for Medicare coverage? How do I go about applying for it? 

If you are turning 65 and plan to begin Medicare, you can apply for coverage up to three months before and three months after your 65th birthday through Social Security. Unless you are still working and have comparable coverage through your employer, you could incur late enrollment penalties if you don’t sign up during your Initial Enrollment Period. 

You can sign up for Medicare by:

  • Visiting Social Security services online
  • Going to your local Social Security office
  • Calling Social Security at 1-800-772-1213 (toll free) or 1-800-325-0778 (toll-free TTY for the hearing/speech impaired), Monday through Friday, 7 a.m. to 7 p.m. ET


Am I able to apply for Medicare if I do not plan on retiring at 65?

If you or your spouse plan to continue working past the age of 65 and you want to keep your employer-based health coverage, you do not need to enroll in Medicare until you retire. If you prefer to enroll in a Medicare plan even through you or your spouse is still working you may do so. You can then choose to keep your employer health plan, or if you choose to disenroll, ask your employer about their rules for disenrolling.


Should I apply for Medicare if I am already receiving Social Security benefits?

You do not need to apply for Medicare if you are already receiving Social Security benefits, as you will be automatically enrolled in the Medicare program through those benefits. You should receive your Medicare card and coverage documents from your Social Security office approximately 90 days before your 65th birthday. Once you have your red, white and blue Medicare card, you can choose to enroll in a Medicare Advantage plan like Sharp Direct Advantage, or other types of additional Medicare coverage.


How do I get Medicare Part D drug coverage?

You can receive Medicare Part D coverage by enrolling in a qualifying plan, such as a Medicare Advantage with Part D coverage (MAPD) or Sharp Direct Advantage. If you do not enroll in a plan with Part D drug coverage when you are first eligible, you may receive late enrollment penalties from Medicare.


Understanding Medicare coverage and costs

What is Original Medicare? How do I use my Original Medicare benefits?

Original Medicare refers to Part A (Hospital Insurance) and Part B (Medical Insurance). When you visit a medical provider that accepts Medicare patients, these visits are covered with a cost share from Medicare. Although Original Medicare may cover a percentage of your care, there is no cap on your out-of-pocket costs and most drugs are not covered. Most people with Medicare enroll in additional coverage, such as a Medicare Advantage plan (like Sharp Direct Advantage), Medicare Supplement (Medigap) plan or stand-alone Medicare prescription drug plan.


Is there a cost for Medicare? 

Most people pay no premium for Part A but do pay a monthly premium for Part B, which may vary by your income level and when you enrolled. Depending on income, some people also pay a monthly premium for Part D. These premiums are payable to Medicare and are typically deducted from your Social Security check if you receive one.


How do Medicare Advantage plans work? 

Private insurance companies like Sharp Health Plan offer Medicare Advantage plans, or Part C plans. These plans always offer at least the same benefits as Original Medicare and usually more. Depending on the plan, premiums can be as little as $0 per month. These plans combine Part A, Part B and usually Part D into one comprehensive plan, and may add benefits not found in Original Medicare, like hearing and vision. When you enroll in a Medicare Advantage plan, you must only use in-network providers (except in emergency situations).


What is the difference between Medicaid and Medicare? Can I qualify for both? 

Medicaid (known as Medi-Cal in California) is a state health care program available to people who qualify based on low income status. Medicare is a federal health care program available to people who are 65 and older, as well as people under 65 with specific qualifying disabilities, or people with end-stage renal disease (ESRD). If you think you may qualify for Medi-Cal, you should speak with a representative of your local Social Security office. 


Getting enrolled

What are the requirements to enroll in the Sharp Direct Advantage Medicare plan? 

To enroll in Sharp Direct Advantage, you must meet the following requirements:

  1. Have Medicare Part A and be eligible for Medicare Part B
  2. Reside in San Diego County 
  3. Enroll during a valid enrollment period.
  4. Not have end-stage renal disease (ESRD), except under specific circumstances 


How do I enroll in a Sharp Medicare health plan?

You can choose how you would like to enroll


How can I check my enrollment status?

Contact Customer Care at 1-855-562-8853 (TTY/TDD 711) to check your enrollment status. For your convenience, our office hours are 8 a.m. to 8 p.m. 7 days per week from October 1 to March 31: 7 days per week 8 a.m. to 8 p.m. From April 1 to September 30: Monday through Friday, 8 a.m. to 8 p.m. and on weekends and holidays, your call will be handled by our voicemail system. A Customer Care Representative will return your phone call the next business day. 


Paying my bill

I elected to have my premiums deducted from my Social Security/checking account, but I am still getting a bill. Do I need to pay this?

No. If you have automatic payments set up, you do not need to pay the bill. Social Security deductions take place at the end of the month, after Sharp Health Plan creates billing statements. Your statement should show the previous month's payments. This confirms that your automatic payments are processing, and that you do not need to pay the bill.


 

If you have additional questions, please contact us at Sharp Direct Advantage. We're here to help.



 

Sharp Direct Advantage is offered by Sharp Health Plan. Sharp Health Plan is an HMO with a Medicare contract. Enrollment with Sharp Health Plan depends on contract renewal. Read the full disclaimer.

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Page Last Updated: 10/08/2018
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