Coverage and Benefits
Who Can Join?
Troy Medicare is available to anyone who is eligible for Medicare Part A and Part B and resides in Iredell, Robeson, Rowan, or Cabarrus counties in North Carolina. If you are interested in enrolling in Troy Medicare, you can call us at 1-888-494-TROY (8769) or go to the Documents and Forms page to download and complete an enrollment form. If you complete an enrollment form, you can mail it to us or call us to find a pharmacy location near you to drop it off.
Summary of Benefits
One of the best things about Troy Medicare is that there is only one simple plan option: Troy Medicare (HMO) with a $0/month premium. Here is the booklet with the Summary of Benefits.
Evidence of Coverage
An Evidence of Coverage (EOC) is a document that provides information on the plan, providers, benefits information including what is covered and how much you as a member has to pay for those benefits, how to ask us to cover a service, how to file an appeal if we deny coverage for a service you think should be covered, and how to file a grievance if you are dissatisfied with the plan or a plan provider or pharmacy. Read the Evidence of Coverage document.
Certain benefits require an approval in advance. When a benefit needs approval in advance, you or your provider can submit a medical coverage determination request. These benefits are marked with an asterisk in your Evidence of Coverage booklet, Chapter 4, Benefit Listing.
Your relationship with your Primary Care Provider (PCP) is very important. Your PCP will coordinate your care and make referrals to specialists or for diagnostic services. You do not need a referral for specialist visits, but it is advised to see your PCP first to make sure you are going to the right specialist.
Durable Medical Equipment (DME) List
Certain medical equipment that is ordered by your doctor for medical reasons is covered byTroy Medicare. Your copay is $0 for DME products up to $90.
We have partnered with Hearing Care Solutions to provide hearing exams and if needed, hearing aids.Read More about the Hearing Benefits
We have partnered with NationsOTC to provide access to Medicare covered Over-the-Counter products.Read the OTC Benefits Brochure
We have partnered with Liberty Dental to provide preventive dental services to our members.Read the Dental Benefits Brochure
We have a reimbursement benefit for vision exams and eyewear.Read the Vision Benefits Brochure