Find answers to the most commonly asked Medicare questions

  • Coronavirus (COVID-19)
  • Monkeypox
  • Members
  • Shoppers
  • Billing
  • Pharmacy
Questions about Coronavirus (COVID-19)

Who can get the COVID-19 vaccine?

The County of San Diego is currently vaccinating individuals 6 months and older. You do not need to contact your doctor before your — or your child’s — appointment unless you have a specific medical question. For the latest COVID-19 vaccine information, please visit Sharp HealthCare’s website. You can also reference this COVID-19 Vaccination Schedule from the Centers for Disease Control and Prevention.

How can I get my vaccine?

Please visit a provider in your plan network to receive your COVID-19 vaccine. You can also call 2-1-1 for help scheduling a COVID-19 vaccine.

You can visit CVS Minute Clinic to receive the COVID-19 vaccine throughout San Diego County. You can schedule an appointment here.

For more information on how to get the COVID-19 vaccine, please visit Sharp HealthCare’s website.

I’m homebound and can't make it to a COVID-19 vaccine clinic. What should I do?

Sharp Health Plan and our plan medical groups are doing outreach to members who have been identified as homebound (or unable to leave their home due to illness or old age) to ensure that anyone who can't get to a COVID-19 vaccination site is still able to get vaccinated. If you are homebound and your primary care physician or plan medical group has not reached out to you to schedule your COVID-19 vaccination, please contact our Customer Care team so that we can assist you.

How do I replace my lost vaccination card?

Now you can show digital proof of your vaccination. If you were vaccinated in California, go to and enter your info to access it. (We recommend that you use the latest version of Chrome, Firefox, or Safari for the best experience.)

Is the vaccine covered under my benefits?

Yes. The vaccine is covered at $0 under your preventive care benefits.

Is Sharp offering COVID-19 vaccine booster shots?

Yes. Sharp is offering booster shots to those who are eligible. To see who is eligible for booster shots at this time, please visit Sharp HealthCare’s website. If you are eligible for a booster shot, it will be covered at $0 under your preventive care benefits.

What is the difference between an additional dose and a booster shot?

To provide the best possible protection for immunocompromised individuals, the Centers for Disease Control and Prevention (CDC) recommends an additional (third) dose for those who received either Pfizer or Moderna for their initial series. This third dose is not considered a booster shot. If you are immunocompromised, you are eligible for an additional dose 28 days after the second dose of your Pfizer or Moderna vaccine. Research shows that the immune system of many immunocompromised individuals does not produce the same response that a two-shot course produces in healthy people. If you are immunocompromised, the third dose of the vaccine will be covered at $0 under your preventive care benefits.

The CDC and FDA approved booster shots for healthy individuals because research has shown that the vaccine effectiveness begins to wane after 6 months. For more information on booster shots please visit Sharp HealthCare’s website.

Where can I learn more about the vaccine?

Please visit the County’s website and Sharp HealthCare’s website for up-to-date information about COVID-19 and the vaccine.

About COVID-19

What is COVID-19?

Coronavirus is a type of virus that causes respiratory illness — an infection of the airways and lungs. COVID-19 is a new strain of coronavirus. It’s part of the same family of coronaviruses that includes the common cold.

How can I get free N95 face masks?

The Biden administration is making N95 high-filtration face masks available for free. Three masks will be given out per person pending availability. According to White House officials, a limited number of masks are available now, with more arriving in coming days, and the program will be fully running by early February 2022. Nearly all the pharmacies and community health care centers that participated in the government’s free vaccine program have agreed to be pickup points for the free mask program. This means most major chains, such as CVS Pharmacy®, Rite Aid® and Walgreens® will have them, along with many independent locations. You may want to call in advance to ensure a location has masks available for pickup.

How can I protect myself?

The best way to prevent infection is to get a COVID-19 vaccine. The FDA has authorized three vaccines that have proven to be up to 95% effective in protecting against COVID-19. Be sure everyone in your family who is eligible for the vaccine is vaccinated against COVID-19.

What are the everyday preventive actions I should be taking?

In addition to basic health and hygiene practices, like handwashing, the Centers for Disease Control and Prevention (CDC) recommends the following prevention tips:

  • Staying up to date with COVID-19 vaccines
  • Improving ventilation
  • Getting tested for COVID-19 if needed
  • Following recommendations for what to do if you have been exposed
  • Staying home if you have suspected or confirmed COVID-19
  • Seeking treatment if you have COVID-19 and are at high risk of getting very sick
  • Avoiding contact with people who have suspected or confirmed COVID-19

Please also follow these prevention tips as needed:

  • Wearing masks or respirators
  • Increasing space and distance

How can I get free N95 face masks?

Please visit the CDC’s free N95 mask finder tool online. The tool allows you to search for a list of pharmacies that provide free N95 masks near you based on your zip code. It does not show their current inventory, so please check with the location for availability.

What is Sharp doing to protect patients, visitors and staff during this time?

Sharp HealthCare’s top priority is the safety and well-being of patients, visitors and staff. Please visit for the latest information, such as the following:

  • Hospital visitation guidelines
  • How Sharp is screening and testing patients
  • How to get care
  • Infection prevention measures
  • Sharp classes and events
We encourage you to check Sharp’s COVID-19 page often for updates.

Where can I get more information?

To learn more about COVID-19, please visit the Centers for Disease Control and Prevention, the World Health Organization and the San Diego County Health & Human Services Agency. If you have additional questions, please call 211 San Diego.

We also encourage you to visit for the latest information from Sharp.

Access to care

When will Sharp HealthCare resume scheduling elective and essential surgeries and procedures?

Sharp has begun the resumption of elective and essential surgeries and procedures, but not at the same levels prior to the COVID-19 pandemic. If you have questions about a procedure or surgery that was postponed, please contact your physician.

Can I still go to MinuteClinic?

Yes. You can still visit MinuteClinic®. Please visit the MinuteClinic page on our website for additional information.

Benefits and coverage

Will my benefits cover isolation and quarantine for the diagnosis of COVID-19?

Sharp Health Plan covers medically necessary isolation and quarantine in the hospital. We do not cover home isolation or quarantine.

What are my options if I have been recently affected by income changes, reduced hours, or layoffs?

If your current coverage has been impacted by recent events, you likely qualify for the special enrollment expansion. Learn more about the special enrollment expansion or start an application by getting a quote.

Read more FAQs about special enrollment ➜

I have an individual and family plan, but due to the coronavirus, I need to make adjustments. What should I do?

If you purchased your coverage directly through Sharp Health Plan and need to make changes to your current plan, you have the following options:

If you purchased your plan through Covered California and would like to report an income change, add or remove a dependent, or change your plan, log in to your Covered California account.  

Contact tracing

What is contact tracing?

Contact tracing is a method of disease control that local, state and federal public health officials have been practicing for decades. It helps keep communities safe by identifying people who may have come into contact with an infected person. According to the Centers for Disease Control and Prevention, contact tracing and self-quarantining of people with COVID-19, and close contacts, is critical to slowing transmission of COVID-19 in our communities. For more information, check out this Sharp Health News article on the importance of contact tracing.

How does contact tracing for COVID-19 work?

If you test positive for COVID-19, your doctor or another health official will let you know. A positive case must be reported to County Public Health Services so that each confirmed case can be used to help identify others who may have been exposed. When a confirmed COVID-19 case is investigated by public health staff, the investigator works with the infected person to identify all close contacts they may have exposed. Contact tracers then attempt to get in touch with these contacts so that they can be self-quarantined at home and monitored for symptoms of COVID-19. For more information, watch this short video from the County of San Diego Communications Office.

Who conducts COVID-19 contact tracing and how?

Contact tracing is conducted by local and state public health officials. If you had contact with someone infected with COVID-19, you may first get a text message from the health department telling you that you’ll get a call from a specific telephone number. When the contact tracer calls, they will identify themselves as being part of the county, and let you know that all information gathered during the contact tracing effort is kept confidential. Contact tracers will not ask you for personal information such as your Social Security number, bank account or credit card information. Anyone who does is a scammer.

How do I spot a contact tracing scam?

According to the Federal Trade Commission, scammers pretending to be contact tracers are taking advantage of how the process works, and are also sending text messages. You can spot spam text messages because they’ll ask you to click a link. Unlike a legitimate text message from a health department, which only wants to let you know they’ll be calling, text messages from scammers include a link to click.

Testing and treatment

Where can I get tested for COVID-19?

Call your doctor first if you are concerned about possible exposure to COVID-19, or are experiencing symptoms such as a cough, fever or shortness of breath. Your doctor will assess your situation and recommend where you should be seen. In some cases, your doctor may recommend that you stay home and treat mild symptoms. Not all patients need to be tested. Testing is provided based on a risk assessment recommended by the CDC.

Is medically necessary COVID-19 testing covered by my insurance?

Yes. Sharp Health Plan covers COVID-19 testing when an authorized health care provider gives the test or has referred you to get a test for personal diagnosis or treatment. COVID-19 diagnostic testing is covered for members with or without symptoms, whether or not you have been exposed to COVID-19. Medically necessary testing and related items and services are covered at no cost to you.

Is COVID-19 testing required by my employer covered by my insurance?

No. Non-diagnostic testing required for employment or public health surveillance is generally not covered. Non-diagnostic tests are tests related to public health surveillance, general workplace health and safety, or for other purposes not primarily intended for individualized diagnosis or treatment of COVID-19 (e.g., when an employer or other entity requires repeated or mass testing for surveillance or employment purposes).

How can I get free at-home COVID-19 tests?

Free at-home COVID-19 tests are no longer available at, as of Wednesday, May 31, 2023. Please contact a HRSA health centerTest to Treat site, or ICATT location near you to learn how to access low- or no-cost COVID-19 tests provided by the federal government.

Are at-home COVID-19 tests covered by my insurance?

Yes. Sharp Health Plan will reimburse members for a limited number of at-home COVID-19 tests purchased on or after Jan. 15, 2022 with or without a prescription. Tests submitted for reimbursement must be authorized by the U.S. Food and Drug Administration (FDA). The FDA features lists of approved tests on its website.

How many at-home tests can I submit for reimbursement?

Sharp Health Plan will cover 8 individual at-home COVID-19 tests per month for each member for tests purchased on or after Jan. 15, 2022. Tests may be packaged individually or with multiple tests in one package (for example, two tests packaged in one box).

How do I get reimbursed for at-home tests?

To request reimbursement, you’ll need to complete our at-home COVID-19 test member reimbursement form. You will need the brand name and the Universal Product Code (UPC) from the at-home test box to complete the form. An itemized sales receipt is also required. The UPC is listed underneath the barcode and is typically a 12-digit number.

How long will it take to get my reimbursement?

It will take us 30 days from the date we receive your request to process your reimbursement. If your request is approved, you’ll receive a check for your total reimbursement amount by mail. If your request is denied, you will be notified by mail. If you have questions about your reimbursement, please contact Customer Care.

What if I need more than 8 at-home tests per month?

If your provider determines that it is medically necessary for you to purchase more than 8 at-home tests in a single month, then you will need to get a physician’s order from them and submit it along with your member reimbursement form.

Are at-home COVID-19 tests covered for Medicare members?

If you are enrolled in one of our Sharp Direct Advantage® plans, please visit our Medicare COVID-19 resource center for more information.

How can I get a prescription for Paxlovid or Molnupiravir (Lagevrio)?

Paxlovid and Molnupiravir (Lagevrio) are antiviral medicines that can help you fight COVID-19. These treatments aren’t right for everyone. If one of these treatments is determined to be medically necessary for you, you can get a prescription from your primary care physician, a Test to Treat location or a state-licensed, in-network retail pharmacy like CVS or Walgreens. Please note that you will need to provide your latest medical records and a list of currently prescribed medications to get a prescription from an in-network pharmacy. Please also note that quantity limits and fill restrictions apply to these medications. Please refer to the Sharp Health Plan drug formulary for formulary restrictions.

Will Sharp Health Plan cover the cost of COVID-19 treatment?

Sharp Health Plan’s policy includes coverage for inpatient and outpatient services related to COVID-19 treatment. Services must be provided by Plan providers affiliated with your Plan Medical Group (PMG), unless your PMG has authorized the service in advance, or it is an emergency service. You are responsible for any copay, coinsurance or deductible related to these services to treat COVID-19 or to diagnose COVID-19.

Does Sharp Health Plan cover antibody tests for COVID-19?

Sharp Health Plan will cover, without cost share, serological (antibody) tests that are ordered by an in-network physician or authorized provider, medically necessary, and provided by an in-network laboratory. Sharp Health Plan does not cover serological (antibody) tests for return to work or school, general health surveillance, or self-surveillance or self-diagnosis. Please refer to the CDC website for the most recent guidance on antibody testing.


What is monkeypox?

Monkeypox is a viral infection caused by the monkeypox virus, which is in the same family of viruses that causes smallpox. It’s less contagious than smallpox and usually spreads through close, personal contact. Generally, it does not cause severe illness, and most monkeypox cases resolve on their own. That said, a small number of reported cases have resulted in severe illness and death.

Due to the high number of cases, the World Health Organization has declared the current monkeypox outbreak a global health emergency. And the Centers for Disease Control and Prevention (CDC) has confirmed cases of monkeypox in most parts of the U.S., including San Diego. For more information, please visit the CDC’s website.

How is monkeypox spread?

Monkeypox usually spreads through direct skin-to-skin contact with someone who has a monkeypox rash. It can also be spread by sharing surfaces, clothing, or bedding with an infected person along with blood and/or bodily fluids. Monkeypox can spread from the time symptoms start until the rash has healed, all scabs have fallen off, and a fresh layer of skin has formed. The illness typically lasts 2-4 weeks.

What are the symptoms of monkeypox?

According to the CDC, symptoms of monkeypox can include:

  • Fever
  • Headache
  • Muscle aches and backache
  • Swollen lymph nodes
  • Chills
  • Exhaustion
  • Respiratory symptoms (e.g. sore throat, nasal congestion or cough)
  • A rash that may be located on or near the genitals or anus but could also be on other areas like the hands, feet, chest, face or mouth. The rash will go through several stages, including scabs, before healing. The rash can look like pimples or blisters and may be painful or itchy.

Monkeypox symptoms usually start within 3 weeks of exposure to the virus. If someone has flu-like symptoms, they will usually develop a rash 1-4 days later.

Is there a monkeypox vaccine?

Yes. The County of San Diego is currently prioritizing vaccination for individuals 18 or older who:

  • Have been identified as intimate with or otherwise close contacts of a person diagnosed with monkeypox.
  • Have been intimate or otherwise had skin-to-skin contact with a person who has a monkeypox-like rash.
  • Have attended an event where a diagnosed case has been reported.
  • Are part of a community in which monkeypox infections have been reported. At this time, this includes members of the LGBTQ+ community, including gay, bisexual and other men who have sex with men and have had more than one sex partner in the last month.

For more information on the monkeypox vaccine, visit Sharp HealthCare’s website.

How do I protect myself against monkeypox?

Along with vaccination — recommended for people who have been in close contact with individuals who have monkeypox or who had multiple sexual partners in the past 14 days in an area with known monkeypox cases — the CDC recommends you:

  • Avoid close, skin-to-skin contact with people who have a rash that looks like monkeypox.
  • Do not touch the rash or scabs of a person with monkeypox.
  • Do not kiss, hug, cuddle or have sex with someone with monkeypox.
  • Do not share eating utensils or cups with a person with monkeypox.
  • Do not handle or touch the bedding, towels or clothing of a person with monkeypox.
  • Wash your hands often with soap and water or use an alcohol-based hand sanitizer.

What should I do if I think I may have monkeypox?

If you think you may have monkeypox contact your primary care physician and follow the CDC's isolation guidelines:

  • Do not share items that have been worn, used or handled with other people or animals.
  • Wash and disinfect items that have been worn or handled and surfaces that have been touched.
  • Avoid close physical contact with other people.
  • Avoid crowds and congregate settings, such as residential facilities, dormitories and prisons.
  • Wash your hands often with soap and water or use an alcohol-based hand sanitizer, especially after direct contact with the rash.

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 or call Customer Care at 1-855-562-8853 (TTY 711).

Accessing care

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 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.

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.

Filling prescriptions

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.

Over-the-counter benefit

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 or you can place an order online by visiting Here you can check account information, product availability and process your order.

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


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.

Blue OTC label


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

Create an account

  1. Go to 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

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 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, 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.

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.

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 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.

Applying for coverage

When can I apply for Medicare coverage? How do I sign up?

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.

If you don’t sign up during your Initial Enrollment Period, you could get charged late enrollment penalties, unless you have coverage that’s similar in value to Medicare (like from an employer or through an individual and family plan).

You can sign up for Medicare one of the following ways:

Can I sign up for Medicare if I don’t plan to retire at 65?

If you or your spouse plan to keep working after turning 65, and you want to keep your employer-based coverage, you do not need to enroll in Medicare until you retire.

If you want to enroll in a Medicare plan even though you or your spouse is still working, you may do so. You can then choose to keep your employer-based coverage. Or if you choose to disenroll, ask your employer about their rules for disenrolling.

Should I apply for Medicare if I already get Social Security benefits?

You do not need to apply for Medicare if you’re already receiving Social Security benefits. You get automatically enrolled in Medicare through those benefits.

You should receive your Medicare card and coverage documents from your Social Security office around 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 explore 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. For example, a Medicare Advantage plan with Part D coverage like Sharp Direct Advantage. If you don’t enroll in a plan with Part D drug coverage when you are first eligible, you may be charged a late enrollment penalty 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.

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. Our team is available 7 am to 8 pm, seven days a week.

Paying my bill

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.

Online payments

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.

Coronavirus & COVID-19

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 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 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.

Member ID cards & pharmacy

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:

Members with a Sharp Direct Advantage individual plan (Medicare):

BIN 004336
Group RX4154

Members who have a group Medicare plan through Sharp HealthCare or SDPEBA:

BIN 004336
Group RX4155

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


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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