You can compare Mercy Care Advantage and the Original Medicare Plan using the 2013 Summary of Benefits. The charts within the Summary of Benefits list some important health benefits. For each benefit, you can see what our plan covers and what the Original Medicare Plan covers. The Summary of Benefits also includes the cost sharing amount required for each covered benefit.
Our members receive all of the benefits that the Original Medicare Plan offers. We also offer more benefits, which may change from year to year.
The service area for this plan includes: Maricopa, Pima and Santa Cruz Counties, AZ. You must live in one of these places to join the plan.
To be eligible for Mercy Care Advantage (HMO SNP), you must receive Medicaid medical assistance from the State of Arizona and have Medicare Parts A and B and reside in the approved service area. For AHCCCS Acute or ALTCS Medicaid programs our service area includes Maricopa and Pima counties. For the Arizona Division of Developmental Disabilities our service area is Maricopa, Pima and Santa Cruz counties.
Mercy Care Advantage has formed a network of doctors, specialists and hospitals. You can only use doctors who are part of our network. The health providers in our network can change at any time. You can ask for a current Provider Directory for an up-to-date list or access the Mercy Care Advantage on-line Provider Directory. You can also contact the Mercy Care Advantage Member Services department at (602) 263-3000 or (800) 624-3879, 24 hours a day, 7 days a week. TTY/TDD users should call (866) 602-1982.
If you choose to go to a doctor outside of our network, you must pay for these services yourself, except in limited situations(for example, emergency care). Neither Mercy Care Advantage, nor the Original Medicare Plan will pay for these services.
Yes, the Mercy Care Advantage Plan covers both Medicare Part B and Part D prescription drugs. Please refer to our Evidence of Coverage for more detailed coverage information.
Mercy Care Advantage has a robust network of participating pharmacies available in our plan service area. You must use a network pharmacy to fill your prescriptions. We may not pay for your prescriptions filled at an out-of-network pharmacy, except in limited situations. The pharmacies in our network can change at any time. You can ask for a current Pharmacy Network List or access the Mercy Care Advantage on-line Pharmacy directory. You can also contact the Mercy Care Advantage Member Services department at 602-263-3000 or 1-800-624-3879, 24 hours a day, 7 days a week. TTY/TDD users should call 1-866-602-1982.
Mercy Care Advantage uses a formulary. A formulary is a list of drugs covered by Mercy Care Advantage to meet patient needs. We may periodically add, remove, make changes to coverage limitations on certain drugs or change how much you pay for a drug. If we make any formulary change that limits our members' ability to fill their prescriptions, we will notify the affected enrollees before the change is made. We will send a formulary to you and you can see our complete formulary on-line
If you are currently taking a drug that is not on our formulary or subject to additional requirement or limits, you may be able to get a temporary supply of the drug. You can contact us to request an exception or switch to an alternative drug listed on our formulary with your physician's help. Call us to see if you can get a temporary supply of the drug or for more details about our drug transition policy.
If you qualify for extra help with your Medicare prescription drug plan costs, your premium and costs at the pharmacy will be lower. When you join Mercy Care Advantage, Medicare will tell us how much extra help you are getting. Then we will let you know the amount you will pay. If you are not getting this extra help you can see if you qualify by calling 1-800-Medicare (1-800-633-4227), TTY users should call 1-877-486-2048. You can call this number 24 hours a day, 7 days a week.
All Medicare Advantage Plans agree to stay in the program for a full year at a time. Each year, the plans decide whether to continue for another year. Even if a Medicare Advantage Plan leaves the program, you will not lose Medicare coverage. If a plan decides not to continue, it must send you a letter at least 90 days before your coverage will end. The letter will explain your options for Medicare coverage in your area.
When you join Mercy Care Advantage and you learn that we do not cover a prescription drug you were taking before you joined our Plan, you may be able to get a one temporary fill of a 30-day supply of that prescription drug (or less, as prescribed). You and your doctor will then get a letter from our pharmacy benefits manager, Express Scripts, notifying you that you will need to get a prescription for a formulary drug or request an exception with the help of your doctor.
A Medication Therapy Management (MTM) Program is a free service we may offer. You may be invited to participate in a program designed for your specific health and pharmacy needs. You may decide not to participate but it is recommended that you take full advantage of this covered service if you are selected. Contact Mercy Care Advantage for more details.
As a member of Mercy Care Advantage, you have the right to request a coverage determination, which includes the right to request an exception, the right to file an appeal if we deny coverage for a prescription drug, and the right to file a grievance. You have the right to request a coverage determination if you want us to cover a Part D drug that you believe should be covered. An exception is a type of coverage determination. You may ask us for an exception if you believe you need a drug that is not on our list of covered drugs or believe you should get a non-preferred drug at a lower out-of-pocket cost. You can also ask for an exception to cost utilization rules, such as a limit on the quantity of a drug. If you think you need an exception, you should contact us before you try to fill your prescription at a pharmacy. Your doctor must provide a statement to support your exception request. If we deny coverage for your prescription drug(s), you have the right to appeal and ask us to review our decision. Finally, you have the right to file a grievance if you have any type of problem, with us or one of our network pharmacies, that does not involve coverage for a prescription drug.
4350 E. Cotton Center Blvd.,
Bldg D, Phoenix,
Mercy Care Plan Member Services
7 a.m. to 6 p.m. Monday-Friday
Mercy Care Advantage Member Services
24 hours a day, 7 days a week
Select the Mercy Care Advantage option
If you or a family member has a medical emergency, dial 911.