In order to be eligible for Quartz Medicare Advantage (HMO), in collaboration with Aurora Health Care, you need to live in our service area. Also, in order to be eligible for any Medicare Advantage program, including Quartz Medicare Advantage, you must be eligible for Medicare Part A and enrolled in Medicare Part B.
You can choose from three premium payment options including coupon book, automatic withdrawal from your bank account or automatic withholding from your Social Security check. Please note, we are not able to accept cash payments.
You may send a question through our secure member portal, MyChart, or contact Customer Service.
Quartz Medicare Advantage members are eligible for one routine physical and vision exam every 12 months. If you have questions about the timing of your visit(s), please don't hesitate to contact Customer Service.
Search our Find a Doctor tool or refer to the Provider Directory. You can also contact Customer Service for assistance.
You may change your personal physician through our secure member portal, MyChart, or contact Customer Service for assistance.
Emergency or urgently needed care is covered anywhere in the world when you are traveling outside the service area. For medications (Part D drugs), prescriptions must be obtained within the United States.
You may request an ID card through MyChart or contact Customer Service to have it mailed to you.
Please refer to your Evidence of Coverage to learn more about your rights and responsibilities. You can search for your plan documents, including the Evidence of Coverage, on this web page.
A Durable Power of Attorney (DPOA) allows one individual to make decisions on behalf of another. A DPOA remains effective for life unless it is revoked. There are two types of DPOA, one that applies to financial decisions and one that applies to health care decisions. A General Authorization allows you to designate another individual to discuss your personal information. It does not allow the person to make decisions on your behalf. A General Authorization remains in effect for two years unless revoked. You may also provide verbal consent to allow us to talk with another person you designate as your representative. However, your verbal consent is only valid on the day that it is given. If you would like to have another person continue to assist you, please submit a General Authorization Form to us.
Anyone with current drug coverage through Senior Care, Veterans Administration (VA), Tricare, or a Retiree Plan can choose a Medicare Advantage plan without Part D drug coverage and avoid penalties if their drug coverage is at least as good or better than Medicare Part D coverage. Please contact Customer Service for further details.
Anyone with current drug coverage through Senior Care, Veterans Administration (VA), Tricare, or a Retiree Plan can choose a Medicare Advantage plan without Part D drug coverage and avoid penalties if their drug coverage is at least as good or better than Medicare Part D coverage. Please contact Customer Service for further details.
Quartz Medicare Advantage Part D drug coverage is processed through a pharmacy benefit manager. The Quartz Medicare Advantage pharmacy benefit manager has contracts with over 55,000 pharmacies nationwide, which exceeds the Medicare access guidelines. Therefore, you will have coverage for prescription drugs outside of our service area as long as you choose a pharmacy contracted through pharmacy benefit manager. You can contact us to locate a pharmacy or use our online Provider and Pharmacy Directory.
The amount you pay for your medication(s) can be located in your Plan's Summary of Benefits document.
A medication that contains identical amounts of the same active ingredient in the same dosage form and route of administration that is expected to have the same clinical effects and safety profile as another product as designated by the United States Federal Food and Drug Administration (FDA).
A medication that contains identical amounts of the same active ingredient in the same dosage form and route of administration that is expected to have the same clinical effects and safety profile as another product as designated by the United States Federal Food and Drug Administration (FDA).
To promote the most appropriate utilization, certain medications require an approval of a prior authorization by our Pharmacy Department. Upon enrollment or upon request, the member will receive a list of prior authorized prescription drugs. These medications are also identified on the Formulary with a (PA) after the drug name. Prior authorization criteria is established by our Pharmacy and Therapeutics Committee with input from plan physicians and consideration of the current medical literature. If a medication is required that is not routinely covered, the provider may present medical evidence to obtain an individual patient exception by submitting an exception request for review.
As a member of Quartz Medicare Advantage, you may initiate an exception request process. For your convenience, we have prepared a drug exception request form that you may complete and fax or mail to us.
A mail service pharmacy delivers medicines to your home through the mail. By using a mail service pharmacy you can get up to a 90-day supply of medication, often at a lower copayment. Mail service pharmacies deliver medicines in a confidential package. Many people prefer the convenience of this type of service. Quartz Medicare Advantage members are not required to use a mail service pharmacy. However, if you are interested in using one, more details may be found here - Mail Service Pharmacy.
When purchasing prescription medications, you are encouraged to use your Quartz Medicare Advantage ID card. If for some reason you are unable to utilize your pharmacy card, and are required by the pharmacy to pay for the medications, you may submit your itemized pharmacy receipt to us. Prescription medications purchased from a pharmacy will be reimbursed through our Pharmacy Benefits Management (PBM) at our current discount contracted rates. Any difference between the discount contracted rate and what the provider has billed will be your responsibility.
