Coverage and Benefits
Who Can Join?
To enroll in Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP) you must be eligible for Medicare Part A and Part B, live in Robeson county, and also receive certain levels of assistance from the North Carolina Medical Assistance program (FBDE, SLMB Plus, QMB Plus or QMB). If you receive both Medicare and Medicaid benefits, this means you are a Dual-eligible beneficiary.
Summary of Benefits
One of the best things about Troy Medicare for Dual-eligible Beneficiaries is the $0 copay for Tier 1 generic medications. 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.
OTC Benefits (up to $1,100/year)
We have partnered with NationsOTC to provide access to Medicare covered Over-the-Counter products.Read the OTC Benefits Brochure
Hearing Benefits up to $750
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 Liberty Dental to provide preventive and comprehensive dental services to our members.Read the Dental Benefits Brochure
We have a reimbursement benefit up to $200 towards eyewear and up to $50 for an annual eye exam.Read the Vision Benefits Brochure
Documents and Forms
Want to sign up for a plan? Need to share your health information with a loved one? We've got forms for all that and more.