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Is Part D Part of Medicare?

Medicare Part D was created by the U.S. Congress under the Medicare Modernization Act. It was designed to help people with Medicare cover the cost of their prescription drugs, but it’s not an actual part of the existing Medicare program. Instead, insurance companies and other private companies – like Network Health Insurance Corporation – will seek approval from Medicare to offer specific Medicare Prescription Drug Plans containing Medicare Part D benefits.

In order for people with Medicare to receive this drug coverage, they must choose and enroll in a private plan approved by Medicare. Annual Enrollment begins October 15th and coverage will take effect on January 1st. Individual cost savings will vary, based on personal income level and drug usage.

Three plans provide combined medical and Medicare Part D prescription drug benefits:

Network PlatinumSelect

Covers health care services both in- and out-of-network - and includes Medicare Part D prescription drug coverage with NO deductible - all for a $0 monthly plan premium. Learn more

Network PlatinumPlus Pharmacy

The same benefits as Network PlatinumPlus, including $0 in-network hospital stays, and Medicare Part D prescription drug coverage with NO deductible. Learn more

Network PlatinumPremier Pharmacy

The same health care benefits as Network PlatinumPremier, including $0 copay for in-network services, and Medicare Part D prescription drug coverage with NO deductible and NO coverage gap for generics. Learn more

One plan provides combined medical and Medicare Part D prescription drug benefits for people who have both Medicare and Wisconsin Medicaid:

NetworkCares

A Special Needs Plan that offers health care services, prescription drug coverage, and supplemental benefits including Respite Care and Preventive Dental. There is a $0 monthly plan premium. Learn more

H5215_Website12 CMS Approved 12152011
Last Updated: 1/27/2012

Notice of Privacy Practices (2012)

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Financial Information | Site Map | Network Health Plan (by clicking on this link, you will be leaving the Network Health Medicare-specific web pages)

Network PlatinumPlus, Network PlatinumPremier and Network PlatinumSelect are Medicare Preferred Organizations (PPO) plans offered by Network Health Insurance Corporation, a Medicare Advantage plan with a Medicare Contract. Benefits, formulary pharmacy network, premium and /or copayments and co-insurance may change on January 1, 2013.The Network Health Insurance Corporation Contract is renewed annually, so enrollment in a plan cannot be guaranteed.

We also offer NetworkCares PPO SNP, a $0 premium full dual eligible Special Needs Plan. NetworkCares is a Coordinated Care Plan with a Medicare Advantage contract and contract with the Wisconsin Medicaid Program. This plan is available to anyone who has both Medical Assistance from the State and Medicare. You must continue to pay your Part B premium unless otherwise paid for by Medicaid or by another third party. For information about this Special Needs Plan, please contact us at 1-800-983-7587 or 1-800-947-3529 Monday through Friday 8 a.m. - 8 p.m. From Oct. 15th through Feb. 14th we are available 8 a.m. - 8 p.m., 7 days a week. For the hearing impaired, call TDD/TTY 1–800–947–3529.

Network Cares has been approved by the National Committee for Quality Assurance (NCQA) to operate as a Special Needs Plan (SNP) until 2013/2014. NCQA’s approval is based on a review of NetworkCares Model of Care and is an indicator of compliance with CMS requirements. NCQA’s approval is not an endorsement by CMS and/or NCQA of NetworkCares or the quality of services provided by NetworkCares. NetworkCares will still need to be approved each year by CMS in order to operate. If you have any questions regarding our approval by the NCQA, please contact us at 1-800-378-5234.

You may be eligible for extra help to pay for your prescription drug premiums and costs. To see if you qualify for extra help, call:

  • 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048, 24 hours a day/7 days a week.
  • The Social Security Office at 1-800-772-1213 between 7 a.m. and 7 p.m. Monday through Friday. TTY users should all 1-800-325-0778; or
  • Your State Medicaid Office.

The benefit information provided here is a brief summary, not a comprehensive description of benefits. For more information, please contact the plan.

Network Health Insurance Corporation (NHIC) contracts with a network of providers within the 14 county service area to provide Medicare-covered benefits. Our Network Medicare Advantage plans are open to Medicare beneficiaries eligible by age or disability in the plan’s service area. Our Network Medicare Platinum Plans provide reimbursement for all covered benefits regardless of whether they were received in-network, as long as they are medically necessary. With the exception of emergencies or urgent care, it may cost more to get care from out-of-network providers.

Individuals must have both Medicare Part A and Part B to enroll and continue to pay their Part B premiums, unless otherwise paid for by Medicaid or by another third party. Plan benefit maximum limitations, copayments and restrictions may apply. To qualify, you must be a resident of the service area and not have End Stage Renal Disease (ESRD).

Members may enroll only during certain times of the year. If you enroll in one of our Medicare Advantage Pharmacy plans, you must receive your Medicare prescription drug benefit through the plan. Eligible members must use network pharmacies to access their prescription drug benefit except under non-routine circumstances; quantity limitations and restrictions may apply. Our Network Medicare Advantage Pharmacy plans use a formulary, which is a list of preferred drugs covered by the plan.

A partnership of Ministry Health Care and Wheaton Franciscan Healthcare.