Coverage and Benefits
Who Can Join?
Troy Medicare (HMO) is available to anyone who is eligible for Medicare Part A and Part B and resides in Alexander, Anson, Bladen, Buncombe, Burke, Caldwell, Catawba, Chatham, Columbus, Cumberland, Durham, Franklin, Granville, Harnett, Haywood, Henderson, Hoke, Iredell, Jackson, Lee, McDowell, Mitchell, Montgomery, Moore, Orange, Person, Polk, Richmond, Robeson, Sampson, Scotland, Swain, Transylvania, Vance, or Yancey counties in North Carolina.
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 2023 Summary of Benefits
- Here is the booklet with the 2024 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.
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.
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
OTC Benefits up to $160/year
We have partnered with Solutran to provide access to Medicare covered Over-the-Counter products.
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 (up to $50) and eyewear (up to $200)Read the Vision Benefits Brochure
Troy Medicare has partnered with Sesame to provide you access to a free telehealth benefit in 2023! Sesame is an online telehealth provider that delivers same-day convenient, high-quality, medical care. Services include:
- Primary care
- Same-day urgent care
- Prescription refills
- Acute and chronic consults
- Skin Consults
Here’s how you schedule a telehealth appointment:
- Call 866-316-5866 to reach Sesame’s Customer Service team. The customer service team is available 8AM-8PMEST Monday-Friday and 9AM-6PM on the weekends. If you reach the voicemail, follow the instructions and leave a message and someone will get back to you shortly.
- The customer Service Team Member will help you schedule and book an appointment for $0 out of pocket at a time that works best for you.
- You will receive an email and a text message confirming the appointment and instructions to join the telehealth visit.
- At the time of your appointment, join the meeting on your phone, tablet, or laptop or the provider will call you to get the care you need!
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.