Find answers to the most commonly asked Medicare questions

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).

How do I get started with Silver&Fit during COVID-19?

Getting started with Silver&Fit is easy. While many fitness centers are now closed during the current COVID-19 crisis, Silver&Fit has enhanced its at-home fitness options to help you stay active while sheltering in place. Here’s how you can get started:

1. Visit SilverandFit.com online to register for an account.
2. Enroll in the Home Fitness Program online. You can also enroll over the phone by calling Silver&Fit’s toll-free Customer Services hotline at 1-877-427-4788 (TTY/TDD: 1-877-710-2746).
3. Silver&Fit will send your first home fitness kit to you within 10 days.

Please visit Silver&Fit to learn more.

My gym with Silver&Fit closed due to the COVID-19 crisis. What are my options to stay active?

Silver&Fit has a broad range of at-home fitness options:

• Silver&Fit Home Fitness Kits
• Silver&Fit ASHConnect™ Mobile App
• Silver&Fit Connected!™ Tool
• Silver&Fit Signature Series Classes® Exercise Videos – new!

These options are being offered at no charge to participating members. We encourage you to go to Silver&Fit to learn more.

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 1-855-492-9028, 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.

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.

How do I sign up for mail-order prescriptions?

We offer mail order services through our partner CVS Caremark® Mail Service Pharmacy. Please visit the pharmacy section of our website to learn more. You can also call the dedicated prescription helpline that’s printed on the back of your member ID card for 24/7 assistance.

I tried calling to place an order, but I couldn't get through. Is there another way I can place an order?

We are currently experiencing extreme demand, which is impacting call center wait times, and availability of select preparedness related product categories, like hand sanitizer, wipes and cold & flu products. Our teams are making every effort to prioritize your needs with our suppliers. We sincerely apologize for any inconvenience during these unprecedented circumstances.

As a reminder, you can also can obtain over-the-counter (OTC) items directly from select CVS Pharmacy^® stores (beginning 2022) or you can place an order online by visiting cvs.com/otchs/sharp. Here you can check account information, product availability and process your order.

Below are instructions on how to purchase in-store or order online.

In-store (beginning 2022)

Shop for eligible OTC products — listed in the item catalog with a blue label (pictured below) — at a participating CVS Pharmacy store near you. Once you have selected your approved items, go to any checkout register and show your Sharp Direct Advantage member ID card. Read more important details about in-store shopping here.

Online

Step-by-step instructions for first-time online users

Create an account

1. Go to cvs.com/otchs/sharp online.
2. Click the “Create account” button and follow the instructions.
   • You will need your Sharp Direct Advantage member ID number, date of birth, ZIP code and a current email address. As a friendly reminder, your member ID number is listed on the front of your Sharp Direct Advantage member ID card. 
     Note: You must use a unique email address for your account.
   • You will also need to create a password.
3. Save your account password for future online orders. You will need your member ID or email address and your password to sign in.

Order your OTC items online

1. After you sign in to your account, your benefit amount and balance will be listed at the top of the page.
2. Shop the available products and add items to your basket. Your order total will automatically deduct from your remaining balance at the top of the page.
3. When you are ready to place your order, click on “Checkout.”
4. At the checkout page, confirm your shipping address and make sure your order is correct.
5. Place your order. That’s it!

Your order will arrive in 7–14 days. You’ll receive an email with tracking information to confirm your order is placed, when your order has shipped and another email to confirm when your order has been delivered. If an item in our order is out of stock, you will receive an email notification.

Where can I find my Sharp Health Plan member ID number?

It can be found on the front of your health plan member ID card.

How can I find out what my benefit allowance is?

Our Sharp Direct Advantage Gold and Platinum Card individual plans feature a supplemental over-the-counter (OTC) benefit. Benefit allowances vary depending on your plan. Check your Evidence of Coverage (EOC) to see what plan you’re enrolled in. You can access your EOC online through your Sharp Connect account at sharphealthplan.com/login.

Where can I find an OTC benefit catalog?

You can download the OTC benefit catalog for your plan. You can also have a catalog mailed to you by calling OTC Health Solutions at 1-888-628-2770 (TTY: 711). They are available to assist you Monday through Friday, 6 am to 5 pm Pacific Time.

How do I place my order?

You can place your order either online or over the phone. To order online, visit cvs.com/otchs/sharp and log in with your Sharp Health Plan member ID number and ZIP code.

I take aspirin every day. Can I use my allowance to buy it?

Yes, aspirin is just one of the hundreds of everyday health care products available in the catalog.

Is there a shipping and handling charge?

No. There is no charge to you for shipping and/or handling.

How long does it take to get my order once I’ve placed it?

You should receive your order within 7 to 10 business days of placing your order.

Can I track my orders?

Yes. Visit cvs.com/otchs/sharp, go to My Account and click on Order History. Or you can call 1-888-628-2770 (TTY: 711) to check the status of your order.

What if the cost of my order is less than my allowance?

Let’s say your benefit allowance per quarter is $80 and you spend only $20 on your first order. That means you have another $60 left to use as long as you place the second order before the next quarter begins. Remember, unused benefits do not roll over from one quarter to the next.

What if the cost of my order is more than my allowance?

You won’t be able to place an order for an item that is above your allowance amount.

Can I check my account balance?

Yes. Visit the Sharp Health Plan OTC website and click on My Account to see your balance. Or you can call 1-888-628-2770 (TTY: 711) to find out what your account balance is.

What if I have money left in my account at the end of the quarter? Can I add it to the allowance for the next quarter?

No, the benefit allowance does not roll over into the next quarter. At the beginning of each quarter, your allowance will be reset to your quarterly spending limit.

Can I return my order?

Yes. If you receive a damaged item, please call OTC Health Solutions within 30 days after receiving your order. An identical replacement item will be shipped to you free of charge. No other returns or exchanges are allowed.

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.

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.

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?

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.

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. 

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: 

• Enroll online
• Give us a call
• By mail
• Request a one-on-one appointment

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. 

What is the Sharp Direct Advantage payment book?

Our Sharp Direct Advantage^® payment book is for you to use to help manage your monthly plan premium payments. Your payment book will help you to easily keep track of your payments, see credits you may have on your account and avoid overpaying.

Will I still receive a monthly bill from Sharp Health Plan?

No. The Sharp Direct Advantage payment book will replace your monthly bill from Sharp Health Plan.

How do I read my payment book?

We’ve created a payment book guide to help you understand key points of your payment book. If you still have questions, please contact Customer Care at 1-855-562-8853 (TTY/TDD 711).

What if I don’t want to use my payment book? What are my other payment options?

Visit How to Pay if you would prefer to pay using another method.

What is the difference between automatic bank withdrawals and automatic payments online?

With automatic bank withdrawals, your monthly health plan premium is automatically deducted from your bank account. The benefit of automatic bank withdrawals is that your balance due is always deducted, so you never have to worry about updating your premium amount. The payment portal does not automatically update your payment information when you make a change to your plan benefits. When using automatic payments, you must manually update your premium online to ensure that you’re paying the correct amount.

I elected to have my premiums deducted from my Social Security account, but I still received a payment book. Do I need to use it?

No. If you have automatic payments set up through either Social Security deductions, automatic bank withdrawals or through our payment portal online, then you do not need to use your payment book.

I’ve misplaced my payment book or I never received one. What should I do?

If you’ve misplaced your payment book or never received one, please contact Customer Care at 1-855-562-8853 (TTY/TDD 711) so that we can send you a new one.

What information will I see on the payment portal and what can I do there?

Medicare members will see:

• Current plan
• Online transaction history

You will have options to make either one-time or scheduled automatic payments. 

Is making an online payment secure?

The Sharp Health Plan payment portal is a safe and secure way to pay your premium online. We use Payment Card Industry (PCI) compliant software with a secure payment gateway - technology used to transfer data. 

Will I get confirmation after making my online payment?

After making your online payment, you will receive an on-screen confirmation. You will also receive an emailed confirmation of your payment, including the receipt number and payment amount.

Why can't I view my balance due? 

The ability to view your balance due is currently unavailable, but we hope to offer this feature in the near future. 

Your correct monthly premium can be found on your monthly premium billing statement or 2020 coupon book from Sharp Health Plan. You can also view your billing correspondence on Sharp Connect. Please use this information to update your automatic payments.

I tried to set up a payment method using my American Express or Discover card, but it would not process. Why?

Sharp Health Plan accepts Visa® and Mastercard® credit or debit cards only.

How can I set up automatic payments?

Here are the steps to set up automatic payments:

1. Create an account on the payment portal by entering the required information.
2. Go to the “Automatic payments” page and click “Add automatic payment.”
3. Select your payment method, plan and enter your payment amount.
4. Choose a start and end date for the payments:
   • Start date: The day your payment will be processed each month.
   • End date: The last day your payments will automatically be made. We do not accept automatic payments after the 28th of each month.

Remember to update your automatic payment schedule(s) each year, before December 31. This will ensure accurate and timely premium payments.

Please note that if your payment method fails during a scheduled payment, payments will stop after three (3) failed attempts. To set up automatic payments again, you will have to delete your existing schedule, and create a new one with your updated payment method.

NOTE: You are responsible for canceling your automatic payments if your health coverage is terminated for any reason prior to the end date. Your payment amount is not automatically updated when you make changes to your health plan benefits.

How do I cancel an automatic payment?

To cancel automatic payments:

• Log in to your payment portal account
• Go to the “Automatic payments” page.
• Under "Automatic payments," click on the trash icon located to the right of the scheduled automatic payment.

NOTE: You are responsible for canceling your automatic payments when your health coverage is terminated for any reason or when you no longer wish to make automatic payments.

Do I need to create an account to make a one-time payment?

Yes, all customers will need to create an account in order to make a one-time payment. Creating an account will also allow you to see your online transaction history and set up automatic payments.

I use automatic payments. When I make plan changes are my automatic payments automatically updated?

To ensure your automatic payments reflect your correct monthly premium, we recommend that you update your automatic payments regularly. Our online payment portal does not automatically update your payment information when you make a change to your health plan benefits.

Your correct monthly premium can be found on your monthly premium billing statements from Sharp Health Plan. You can also view your billing correspondence by registering or logging in to Sharp Connect. Please use this information to update your automatic payments.

How can I see my transaction history?

After logging in to your payment portal account, go to the “Transaction history” page. Your transaction history will display payments starting from Jan. 1, 2019. For more information, please call Customer Care at 1-855-562-8853.

How do I change my payment portal email address?

Please call Customer Care at 1-855-562-8853 to change the email address for your payment portal account.

How do I update or change a credit card?

If your credit card information changes, log into the payment portal and select “Profile.” Under the “Payment methods” section, simply delete the old credit card and add the new credit card information. If you update the credit card information used for your automatic payments, you will need to delete the current automatic payment that is set up and create a new automatic payment schedule.

I canceled my plan benefits. Why am I still getting charged?

Our online payment portal does not automatically update your payment information when you end your coverage. Automatic payments will continue until you cancel them. Please log in to the payment portal to cancel any automatic payments.

Will the COVID-19 pandemic affect my ability to get prescriptions filled?

Despite the uncertainty surrounding COVID-19, our goal is to ensure members have timely, safe access to their medications. There are no currently reported drug shortages that would affect your ability to fill prescriptions. For the latest news and information on prescription availability, we encourage you to visit the CVS Caremark^® COVID-19 resource center.

I get my medications in the mail through CVS Caremark, and my last refill was delayed. What’s the reason for the delay?

Medication remains a priority for the U.S. Postal Service (USPS), including transportation, processing and delivery. As a result of ongoing COVID-19 impacts, packages mailed by USPS may require more time to be delivered. It’s a good idea to consider signing up for automatic refills to ensure your prescriptions are processed as quickly as possible. Call CVS Caremark at 1-855-222-3183 to learn more about automatic refills.

How do I find out if my medication will be delayed in the mail?

CVS Caremark assigns tracking numbers to all medications delivered by mail. Your tracking number gives you access to see the current shipping status of your package. As soon as your medication leaves the facility, CVS Caremark will send you an email or text notification (based on the notification preferences you set up in your CVS Caremark account) with a tracking number. You can also check the status of your package by signing in to the pharmacy portal or mobile app, or by calling 1-855-222-3183 to request a status update.

What can I do to ensure I receive my medications on time?

To help give you peace of mind and make sure your refills are processed in a timely manner, CVS Caremark offers automatic refill and renewal services. You can sign up online, or call CVS Caremark at 1-855-222-3183 to learn more. The earliest you may request a refill is when you’ve used up 70% of your current prescription. For a 90-day supply, this means you can get a refill 64 days after you last filled the prescription.

I’ve run out of my medication, and the refill I ordered through CVS Caremark Mail Service Pharmacy hasn’t arrived yet. What should I do?

In these cases, CVS Caremark can provide a one-time Mail Order Delay prescription at a local retail pharmacy. Please call CVS Caremark at 1-855-222-3183 to request a carryover of your medication.

Can I get early refills?

Yes. You can get early refills of most maintenance medications (prescriptions commonly used to treat conditions that are considered chronic or long-term). We are temporarily relaxing early refill limits on maintenance medications. You can get an early refill of up to a 90-day supply of most maintenance medications. Simply tell your pharmacist to use the SCC-13 code when they process your order. Standard copayments and deductibles (if applicable) will apply.

Note: This does not apply to refills of controlled substances, such as certain pain medications. A new prescription from your prescriber is required to provide an emergency supply of a controlled substance.

Can I get my medication delivered to me?

Yes. There are two ways to get your medications delivered to you:

1. Get home delivery

   Many pharmacies are offering free home delivery right now. Please check with your pharmacy for more details on what they may be offering.

2. Sign up for mail order

   Visit caremark.com to sign up and get your maintenance medications delivered to you. Standard shipping is always free. Standard copayments and deductibles (if applicable) will apply.

What should I do if I’m taking a specialty medication?

If you’re taking a specialty medication, please contact the specialty pharmacy that you get your medication from to discuss any alternative delivery arrangements you may need during this time.

What is Sharp Health Plan doing to prevent potential shortages of key drugs?

Sharp Health Plan is closely monitoring current drug supplies. At this time, we do not see any disruptions to the supply chain that would affect your ability to fill your prescriptions. We are taking steps to ensure that patients with COVID-19 are able to get treatment, while members with conditions such as rheumatoid arthritis, HIV and lupus maintain access to medication. As always, we encourage you to fill your prescriptions in a timely manner.

Will there be restrictions or limitations to my over-the-counter (OTC) benefit?

Yes. Members who are enrolled in our Sharp Direct Advantage Gold and Platinum Card individual plans (which include OTC benefits) will experience some temporary limitations. To ensure availability of products for all members, revised order limits have been established for the following products:

• Limit 2 per quarter (every three months)
  • Air shield orange tablets
  • Anti-diarrheal tablets
  • Pink bismuth chewable tabs
  • Antiseptic skin cleanser
  • Rubbing alcohol wipes
  • Children's ibuprofen suspension
  • Children's non aspirin suspension cherry
  • Arthritis pain relief (650mg)
  • Acetaminophen (500mg)
  • Hand sanitizer
  • Vitamin C with rosehips
• Limit 1 per quarter (every three months)
  • Digital thermometers
  • First aid kits
• Temporarily unavailable
  • Cotton swabs
  • Daily fiber SF

Please visit the OTC benefit page for more information and online catalog.

I haven't received my new member ID card, and I can't fill a prescription. What information does my pharmacist need?

 

We recently updated the pharmacy information on the back of your member ID card.

If you have not received a new member ID card with this information — or cannot access your member ID card via the Sharp Connect member portal — and are filling a prescription, please share the following information with the pharmacist:

If you have questions or are experiencing any issues, please call Customer Care at 1-800-359-2002.