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H5696_PUPOTCWS CMS Pending
PUP is an HMO plan with a contract with Medicare, the Federal Government and State Medicaid program. Enrollment in PUP depends on contract renewal. For more information about PUP, please contact us at 1-866-571-0693, TTY/TDD 711 (Mon - Sun 8am - 8pm). The benefit information provided herein is a brief summary, not a complete description of benefits.
For more information contact the plan. Limitations, copayments, and restrictions may apply. Benefits, formulary, pharmacy network, premium and/or co-payments/co-insurance may change on January 1 of each year.
You must continue to pay your Medicare Part B premium.
This plan is available to anyone with Medicare who has both Medical Assistance from the State and Medicare.
Premiums, co-pays, co-insurance, and deductibles may vary based on the level of Extra Help you receive. Please contact the plan for further details.
You may be able to get extra help to pay for your prescription drug premium and costs. To see if you qualify for getting extra help, call: 1-800-MEDICARE (1-800-633-4227). TTY/TDD users should call 1-877-486-2048, 24 hours a day/7 days a week; the Social Security Administration at 1-800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday. TTY/TDD users should call-1-800-325-0778; or your State Medicaid Office.
People with limited incomes may qualify for Extra Help to pay for their prescription drug costs. If eligible, Medicare could pay for up to one hundred (100) percent of drug costs including monthly prescription drug premiums, annual deductibles, and co-insurance. Additionally, those who qualify will not be subject to the coverage gap or a late enrollment penalty. Many people are eligible for these savings and don’t even know it. For more information about this Extra Help, contact your local Social Security office or call 1-800-MEDICARE (1-800-633-4227), 24 hours per day, 7 days per week. TTY users should call 1-877-486-2048.
Other pharmacies, physicians and providers are available in our network.
Plan performance Star Ratings are assessed each year and may change from one year to the next.
Medicare beneficiaries may also enroll in PUP through the CMS Medicare Online Enrollment Center located at http://www.medicare.gov For more information contact PUP at 1-866-571-0693, TTY/TDD 711.
This information is available for free in other languages. Please contact our customer service number at 1-866-571-0693, TTY/TDD 711 (Monday - Sunday 8:00 am - 8:00 pm).
Esta información está disponible de forma gratuita en otros idiomas. Comuníquese con nuestro Servicio de Atención al Cliente al 1-866-571-0693, TTY/TDD 711 (lunes - domingo 8:00 am - 8:00 pm)