A Healthy CollaborationSM

Frequently Asked Questions For Members

Q: How do Private Fee-for-Service Plans like Today’s Options Work?

Todays Options plans provide more coverage than Original Medicare alone, including health and wellness benefits and prescription drug benefits (if applicable with your plan). In addition, there are no networks in Private Fee-for-Service plans. You’re free to visit any doctor or hospital that is willing to provide care and accepts the Today’s Options terms and conditions.
When you enroll in Today’s Options, you are still in the Medicare program and are entitled to all medically necessary health care services that are covered by Medicare.

  • Once you enroll in Today’s Options, you need to pay Part B premiums to Medicare and you may have to pay a Today’s Options monthly premium. Today’s Options also has deductible, co-payment and coinsurance amounts that are different than those under Original Medicare.
  • Before joining the plan, you should carefully check how much your out-of-pocket costs will be. For some beneficiaries, you will have less out-of-pocket costs than you would under Original Medicare combined with a Medicare Supplement policy. A Medicare Supplement policy pays for some or all of the health care costs not covered by the Original Medicare Plan.

Q: Can I use the same doctors and hospitals that I use now or do I need to use a network of physicians?

You can see any licensed provider in the U.S. who can be paid by Medicare and who is wiling to accept the plan’s terms and conditions of payment. You will not be locked into a network of providers. However, a provider may at any time decide that he or she does not want to accept the Today’s Options plan. If this happens, you will need to find another provider who will accept your plan. To make sure this doesn’t happen, you should verify in advance of receiving services that a particular provider is willing to see you.

Q: Do I have to use a primary care doctor like in HMOs?

No, under Today’s Options, you can receive care from any licensed provider who can be paid by Medicare and is willing to accept the plan’s terms and conditions of payment.

Q: What if my provider won’t accept the Today’s Options plan?

Providers are not required to furnish services to members of Today’s Options. If your provider does not want to participate in Today’s Options, then you must seek care from another provider who is willing to furnish services to Today’s Options members. If the provider does provide services to you, he/she will be considered a deemed provider and Today’s Options will pay for the covered healthcare services. You must pay the appropriate co-payments or coinsurance.

Q: Does Today’s Options cover everything that Original Medicare covers?

Yes. Today’s Options must provide enrollees with the same benefits they would receive under Original Medicare. This includes all medically necessary services covered under Medicare Part A and Part B, plus additional benefits not covered by Original Medicare. In addition, you can choose a Today’s Options Value powered by CCRx or Today’s Options Premier powered by CCRx plan that includes prescription drug coverage.

Q: Do I need to continue to pay my Part B premium with Today’s Options?

Yes. You must continue to pay your Part B premium to participate in Today’s Options.

Q: Are my doctors permitted to bill me for services?

No. Today’s Options does not allow doctors, hospitals, and other providers to bill you for more than the plan pays for services.

Q: Where can I get my prescription drugs?

With our agreement with Member Health LLC, you will have access to more than 63,000 pharmacies nationwide.

Q: What drugs are excluded from the Medicare Advantage Prescription Drug Plans (MAPD)?

The drugs that are excluded by Medicare are:

  • Medications used to treat anorexia, weight loss, or weight gain
  • Medications used to promote fertility
  • Medications used for cosmetic purposes or hair growth
  • Medications used to treat erectile dysfunction
  • Prescription vitamins and mineral products, except prenatal vitamins and fluoride preparation
  • Non-prescription drugs
  • Outpatient medications for which the manufacturer requires that associated tests or monitoring services be purchased exclusively from the manufacturer as a condition of sale

In addition, if a medication is covered by Medicare Parts A or B, it cannot be covered under Part D (Medicare Advantage Prescription Drug Plan). Some examples of Parts A or B medications include: diabetic test strips, injectables solely administered in the physician’s office and medications administered in the hospital. Also, each Medicare Advantage Prescription Drug plan may have its own specific exclusions.

Q: What if I already have prescription drug coverage through a Medicare Part D Prescription Drug Plan?

You may elect to drop your Prescription Drug Plan (Part D) and enroll in a Today’s Options Medicare Advantage Prescription Drug Plan between November 15, 2021 and December 31, 2008. We have two plan options that include both medical benefits and prescription drug coverage: Today’s Options Value powered by CCRx and Today’s Options Premier powered by CCRx plans.

Q: What if I have a Medicare Advantage Private Fee-for-Service (PFFS) plan?

If your current Medicare Advantage provider offers a plan with prescription drug benefits you may upgrade your plan to include prescription drugs between January 1, 2009 and March 31, 2009.

Q: What is the difference between a Medicare Advantage (MA) and a Medicare Advantage Prescription (MA-PD) Plan?

Today’s Options offers two types of Medicare Advantage plans—Medicare Advantage (MA) plans and Medicare Advantage Prescription Drug (MAPD) plans. MA plans provide comprehensive medical benefits including doctor visits, hospital coverage, preventive services and more. MAPD plans – our plans “powered by” CCRx -- offer an integrated healthcare package of medical benefits plus Part D prescription drug coverage. All plans from Today’s Options offer generous health and wellness benefits.

Q: What is the coverage gap?

The coverage gap is sometimes called the “donut hole.” This is the amount you pay with a Medicare Advantage Prescription Drug Plan (MAPD) after you reach the initial coverage limit of $2700, and until your total out-of-pocket costs for prescription drugs reach $4350. Some plans, like our Premier powered by CCRx plan, offer coverage on generic drugs during the coverage gap. For more information on the coverage gap, click here or call 1-800-MEDICARE, 24 hours a day, 7 days a week (TTY users 1-877-486-2048). Or visit www.medicare.gov.

Q: How will I know if the prescription drugs I currently take will be covered?

Our plans with prescription drug (Part D) coverage include a comprehensive list of drugs in their formularies. You can find both the Abridged and Comprehensive formularies on our website. You can also contact us at 1-800-685-8260 (TTY/TDD for the hearing impaired 1-800-777-9083), 8 AM to 8 PM, 7 days a week.

Q: Does Today’s Options have materials that are in Spanish?

Yes, Today’s Options has Spanish materials available, such as the 2009 Summary of Benefits. You can request that Spanish materials be mailed to you by calling 1-866-568-8921 (TTY for the hearing impaired: 1-800-958-2692) 8 AM to 8 PM in your local time zone, 7 days a week. A Today’s Options representative will be happy to help you.

M0018_PFFSWebv4_1208 CMS (1/2009) Last updated: 1/1/2022

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