Pre-Enrollment Booklet 2017 FirstMedicare Direct Standard HMO (HMO) FirstMedicare Direct HMO Plus (HMO) FirstMedicare Direct Plus PPO (PPO)

Transcription

1 Pre-Enrollment Booklet 2017 FirstMedicare Direct Standard HMO (HMO) FirstMedicare Direct HMO Plus (HMO) FirstMedicare Direct Plus PPO (PPO) Service Area includes: Chatham, Hoke, Lee, Montgomery, Moore, Richmond and Scotland Counties FirstCarolinaCare Insurance Company s FirstMedicare Direct plans are HMO and PPO health plans with Medicare contracts. Enrollment in FirstMedicare Direct depends on contract renewal. Y0094_17_129 Approved

2 Dear Medicare beneficiary, As you requested, enclosed is information about our three FirstMedicare Direct plans. The information in this booklet will help you explore the benefits of becoming a FirstMedicare Direct member. We encourage you to review the enclosed Summaries of Benefits as they provide detailed information about benefits that our plans offer. Please note that you may enroll in the plan only during specific times of the year, which is explained on the enclosed enrollment form. Benefits and cost sharing may change from year to year. People with limited incomes may qualify for Extra Help to pay for their prescription drug costs. If you qualify, Medicare could pay for up to seventy-five (75) percent or more of your drug costs including monthly prescription drug premiums, annual deductibles, and coinsurance. 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 know it. For more information about this Extra Help, contact your local Social Security office or call MEDICARE ( ), 24 hours per day, 7 days per week. TTY users should call If you choose to enroll, you will receive a confirmation of enrollment letter, followed by your new member Welcome kit. The kit will include materials about your plan, including the Evidence of Coverage, prescription drug formulary, and information about our Provider and Pharmacy Directories. You also will receive an ID card prior to your effective date. Thank you for your interest in FirstMedicare Direct and we look forward to the opportunity to serve you. Sincerely, F. Craig Humphrey President FirstCarolinaCare Insurance Company Y0094_17_129

3 Thank you for your interest in FirstMedicare Direct! We hope this booklet gives you the information you need to make an informed choice. We want to help you pick a plan that works hard for you! It s important to understand what options are available to you as a Medicare beneficiary. We encourage you to take the time to review this information and use the tools included to help you make the best choice for your Medicare coverage. If you want to compare our plan with other Medicare health plans, ask the other plans for their Summary of Benefits booklets. Or, use the Medicare Plan Finder on Inside this kit, you ll find -- Frequently asked questions Summary of Benefits for all three plans we offer includes details about what FirstMedicare Direct plans cover and at what cost Plan Comparison Tool so you can compare different options Partial Provider and Pharmacy Directories and an abridged formulary (drug list) Star Rating information Multi-language interpreter services and non-discrimination notice Enrollment information and application

4

5

6 What is the difference between Medicare Advantage, Part D and Original Medicare? FREQUENTLY ASKED QUESTIONS Original Medicare Part A is hospital coverage that helps cover the costs for inpatient hospital care and skilled nursing facilities (not custodial or long term care, as well as hospice and home health care. Original Medicare Part B covers the costs of doctors services, other outpatient care, as well as tests and laboratory services. Medicare Advantage plans offer all the services covered by original Medicare, in addition to some supplemental benefits not covered by Medicare. Medicare drug coverage (Part D) is offered as a separate purchased plan for individuals with Original Medicare. Part D coverage also may be offered with a Medicare Advantage plan for comprehensive coverage. FirstMedicare Direct plans include Parts A and B coverage, plus Part D prescription drug benefits. Are there any restrictions on what providers I may use? I already pay for Medicare why do I have to pay for a Medicare Advantage plan? How do I find out more about FirstMedicare Direct? Many Medicare Advantage plans require you to use network providers in order to be covered, including FirstMedicare Direct HMO plans. However, if you have an emergency you will be covered whether the emergency facility is in or out-ofnetwork. PPO plans allow you the choice of going to a network or out-of-network provider; if you go to an out-of-network provider you may have a higher share of costs. Under original Medicare alone, services are not 100% covered and may require significant out-of-pocket costs. Many people enjoy the security of having a plan that limits their total annual out-of-pocket costs in case they should have a significant medical event. Our members also like the fact that FirstMedicare Direct includes a prescription drug benefit. If you are considering enrolling, and have questions about benefits, providers or pharmacies or need help with the enrollment process, we have knowledgeable licensed sales representatives who can get you the answers and help you need. Call toll-free at Hearing impaired persons can call TTY 711. How do I enroll? 1. You can enroll by phone at the toll free number above 2. You can enroll online by going to and clicking on ENROLL NOW 3. You can complete the enclosed paper enrollment form 4. Medicare beneficiaries may also enroll in any available plan through the CMS Medicare Online Enrollment Center located at

7 Benefits 2017 Plan Comparison Tool HMO HMO Plus PPO Plus Other Standard Total Monthly Plan Premium $10 $44 $65 Annual Premium Cost $120 $528 $780 Part C Deductible $0 $0 $0 Part D Deductible $300 $0 $0 Annual Maximum Out-of-Pocket Amount $3,400 $3,400 In-Network: $3,400 Combined In and Out-of- Network: $5,100 Primary Care Provider $35 copay $15 copay In: $25 copay Out: 20% coinsurance Specialty Care Provider Inpatient Hospital $50 copay $45 copay In: $45 copay Out: 20% coinsurance $325 copay per day for days 1-6 $0 copay for days 7-90 $275 copay per day for days 1-6 $0 copay for days 7-90 In:$275 copay per day for days 1-6 $0 copay for days 7-90 Out:20% coinsurance Emergency Care $75 copay $75 copay $75 copay Prescription Drugs 30 days at retail Tier 1 Tier 2 Tier 3 Tier 4 Tier 5 Fitness Center Membership $9 copay $20 copay $45 copay $90 copay 25% coinsurance $6 copay $20 copay $45 copay $90 copay 33% coinsurance $10 a month Included at no cost $7 copay $20 copay $45 copay $90 copay 33% coinsurance Included at no cost

8

9 2017 Summary of Benefits FirstMedicareDirect HMO Standard (HMO) H This is a summary of drug and health services covered by FirstMedicare Direct HMO Standard January 1, December 31, 2017 The benefit information provided is a summary of what we cover and what you pay. It does not list every service that we cover or list every limitation or exclusion. To get a complete list of services we cover, please request the Evidence of Coverage. To join FirstMedicare Direct HMO Standard you must be entitled to Medicare Part A, be enrolled in Medicare Part B, and live in our service area. Our service area includes the following counties in North Carolina: Chatham, Hoke, Lee, Montgomery, Moore, Richmond, Scotland. FirstMedicare Direct HMO Standard has a network of doctors, hospitals, pharmacies, and other providers. If you use the providers that are not in our network, the plan may not pay for these services. FirstCarolinaCare Insurance Company's FirstMedicare Direct plans are HMO and PPO health plans with a Medicare contract. Enrollment in FirstMedicare Direct depends on contract renewal. H6306_17_209 Accepted 08/23/2016

10 PREMIUM and BENEFITS FirstMedicare Direct WHAT YOU SHOULD KNOW HMO Standard Monthly Plan Premium You pay $10 You must continue to pay your Medicare Part B premium. Deductible You pay nothing This plan does not have a medical deductible. Maximum Out of Pocket $3,400 annually The most you pay for copayments, coinsurance, and other costs of medical services for the year. Inpatient Hospital Care 1 Doctor Visits Primary Care Specialist SERVICES WITH A 1 MAY REQUIRE PRIOR AUTHORIZATION. YOU PAY $325 Copayment per day for days 1 through 6; YOU PAY $0 for days 7 through 90 YOU PAY $35 Copayment YOU PAY $50 Copayment The copayments for hospital and skilled nursing facility (SNF) benefits are based on benefit periods as defined by Medicare. Preventive Care YOU PAY $0 Includes but not limited to: bone mass measurement; mammogram; cardiovascular screenings; cervical/vaginal screening; diabetes screening; PSA; vaccinations; annual wellness visit Emergency Care Copayment is waived if admitted YOU PAY $75 Copayment within 48 hours Worldwide Emergency Coverage $10,000 lifetime limit for worldwide coverage Urgently Needed Services YOU PAY $30 Copayment Diagnostic Tests, Lab, Therapeutic Radiology Services YOU PAY 20% Coinsurance Such as MRIs, CT scans, outpatient x- rays Hearing Services YOU PAY $50 Copayment Exam to diagnose and treat hearing and balance issues Dental Services YOU PAY $50 Copayment Limited dental services (this does not include services in connection with care, treatment, filling, removal, or replacement of teeth) Vision Services Medicare Covered Eye Exam YOU PAY $50 Copayment Diagnose and treat diseases and conditions of the eye Medicare Covered Annual Glaucoma Test YOU PAY $0 Post Cataract Surgery Eyewear YOU PAY 20% Coinsurance Outpatient Mental Health YOU PAY $40 Copayment Group or individual therapy visits S i

11 Inpatient Mental Health Care 1 Skilled Nursing Facility (SNF) 1 Outpatient Rehabilitation Services YOU PAY $325 Copayment per day for days 1 through 6; YOU PAY $0 for days 7 through 90 YOU PAY $20 Copayment per day for days 1 through 20; YOU PAY $150 per day for days YOU PAY $40 Copayment Inpatient psychiatric care covers up to 190 days in a lifetime in a psychiatric hospital. This limit does not apply to inpatient mental services provided in a general hospital. This plan covers 100 days per cause Occupational, physical, speech and language therapies Ambulance 1 YOU PAY $300 Copayment Medically necessary ground or air medical transportation Transportation NOT COVERED Non-medical transportation is not a covered service. Foot Care (podiatry services) YOU PAY $50 Copayment Foot exams and treatment if you have diabetes-related nerve damage and/or meet certain conditions Durable medical equipment 1 YOU PAY 20% Coinsurance Includes wheelchairs, oxygen, etc. Fitness Center Membership YOU PAY $10 per month If member does not reside within 15 miles of a FirstHealth Health & Fitness Facility, you can be reimbursed up to $180 per yr for fees for FCC approved fitness facility. Medicare Part B Drugs YOU PAY 20% Coinsurance Cardiac Rehabilitation YOU PAY $0 Cardiac (heart) rehab services (for a maximum of 2 one-hour sessions per day for up to 36 sessions up to 36 weeks) Chiropractic Care YOU PAY $20 Copayment Manipulation of the spine to correct a subluxation (when 1 or more of the bones of your spine move out of position) Diabetes Supplies and Services YOU PAY $0 if purchased at Diabetes monitoring supplies pharmacy or 20% Coinsurance if purchased from other supplier YOU PAY $0 Diabetes self-management training YOU PAY 20% Coinsurance Therapeutic shoes or inserts Home Health Care YOU PAY 15% Coinsurance Outpatient Surgery YOU PAY $300 Copayment Ambulatory or Outpatient Hospital One copayment for bilateral cataract surgery if both performed in same calendar year

12 Annual Physical Exam YOU PAY $0 Part D Deductible TIERS SUPPLEMENTAL BENEFITS YOU PAY $300 Annually Does not apply to Tier 1 drugs STANDARD RETAIL COST- STANDARD MAIL ORDER COST- SHARING SHARING One month (30 day) supply dispensed Tier 1 (Preferred Generic) YOU PAY $9 YOU PAY $3 Tier 2 (Generic) YOU PAY $20 YOU PAY $20 Tier 3 (Preferred Brand) YOU PAY $45 YOU PAY $45 Tier 4 (Non-Preferred Brand) YOU PAY $90 YOU PAY $90 Tier 5 (Specialty) YOU PAY 25% of the cost YOU PAY 25% of the cost Two month (60 day) supply dispensed Tier 1 (Preferred Generic) YOU PAY $18 YOU PAY $3 Tier 2 (Generic) YOU PAY $40 YOU PAY $40 Tier 3 (Preferred Brand) YOU PAY $90 YOU PAY $90 Tier 4 (Non-Preferred Brand) YOU PAY $180 YOU PAY $180 Tier 5 (Specialty) Not Offered Not Offered Long Term (90 day) supply dispensed Tier 1 (Preferred Generic) YOU PAY $27 YOU PAY $3 Tier 2 (Generic) YOU PAY $60 YOU PAY $50 Tier 3 (Preferred Brand) YOU PAY $135 YOU PAY $ Tier 4 (Non-Preferred Brand) YOU PAY $270 YOU PAY $225 Tier 5 (Specialty) Not Offered Not Offered Cost-sharing may change depending when you enter another phase of the Part D benefit. For more information on the phases of drug coverage, PRESCRIPTION DRUGS please call us or access our Evidence of Coverage, Chapter 6, at our website

13 For more information, if you are a member, please call Member Services toll free at (TTY users call 711). If you are not a member call us toll free at From October 1 to February 14, you can call 7 days a week from 8:00 a.m. to 8:00 p.m. Eastern. From February 15 to September 30, you can call Monday through Friday from 8:00 a.m. to 8:00 p.m. Eastern. Or you can visit us at You can search our plan s provider and pharmacy directories on our website at We cover Part D drugs. In addition we cover Part B drugs such as chemotherapy and some drugs administered by your provider. You can see the complete plan formulary (list of Part D prescription drugs) and any restrictions on our website at More information about your options under Medicare is available through the Medicare publication, Medicare and You. You can get it at the Medicare website or by calling MEDICARE ( ), 24 hours a day, 7 days a week. TTY users should call

14

15 2017 Summary of Benefits FirstMedicareDirect HMO Plus (HMO) H This is a summary of drug and health services covered by FirstMedicare Direct HMO Plus January 1, December 31, 2017 The benefit information provided is a summary of what we cover and what you pay. It does not list every service that we cover or list every limitation or exclusion. To get a complete list of services we cover, please request the Evidence of Coverage. To join FirstMedicare Direct HMO Plus you must be entitled to Medicare Part A, be enrolled in Medicare Part B, and live in our service area. Our service area includes the following counties in North Carolina: Chatham, Hoke, Lee, Montgomery, Moore, Richmond, Scotland. FirstMedicare Direct HMO Plus has a network of doctors, hospitals, pharmacies, and other providers. If you use the providers that are not in our network, the plan may not pay for these services. FirstCarolinaCare Insurance Company's FirstMedicare Direct plans are HMO and PPO health plans with a Medicare contract. Enrollment in FirstMedicare Direct depends on contract renewal. H6306_17_109 Accepted 08/23/2016

16 PREMIUM and BENEFITS FirstMedicare Direct HMO Plus WHAT YOU SHOULD KNOW Monthly Plan Premium You pay $44 Deductible You pay nothing You must continue to pay your Medicare Part B premium. This plan does not have a deductible. Maximum Out of Pocket The most you pay for copayments, $3,400 annually coinsurance, and other costs of medical services for the year. SERVICES WITH A 1 MAY REQUIRE PRIOR AUTHORIZATION. Inpatient Hospital Care 1 Doctor Visits Primary Care Specialist YOU PAY $275 Copayment per day for days 1 through 6; YOU PAY $0 for days 7 through 90 YOU PAY $15 Copayment YOU PAY $45 Copayment The copayments for hospital and skilled nursing facility (SNF) benefits are based on Medicare defined benefit periods. Preventive Care YOU PAY $0 Includes but not limited to: bone mass measurement; mammogram; cardiovascular screenings; cervical/vaginal screening; diabetes screening; PSA; vaccinations; annual wellness visit Emergency Care YOU PAY $75 Copayment Copayment is waived if admitted within 48 hours Worldwide Emergency Coverage $10,000 lifetime limit for worldwide emergency coverage Urgently Needed Services YOU PAY $30 Copayment Diagnostic Tests, Lab, YOU PAY 20% Coinsurance Such as MRIs, CT scans, outpatient x-rays Therapeutic Radiology Services and X-rays Hearing Services YOU PAY $45 Copayment Exam to diagnose and treat hearing and balance issues Dental Services YOU PAY $45 Copayment Limited dental services (this does not include services in connection with care, treatment, filling, removal, or replacement of teeth) Vision Services Medicare Covered Eye Exam YOU PAY $45 Copayment Diagnose and treat diseases and conditions of the eye Medicare Covered Annual YOU PAY $0 Glaucoma Test Post Cataract Surgery Eyewear YOU PAY 20% Coinsurance

17 Outpatient Mental Health S i Inpatient Mental Health Care 1 Skilled Nursing Facility (SNF) 1 Outpatient Rehabilitation Services YOU PAY $40 Copayment YOU PAY $275 Copayment per day for days 1 through 6; YOU PAY $0 for days 7 through 90 YOU PAY $0 Copayment per day for days 1 through 20; YOU PAY $150 per day for days YOU PAY $30 Copayment Group or individual therapy visit Inpatient psychiatric care covers up to 190 days in a lifetime in a psychiatric hospital. This limit does not apply to inpatient mental services provided in a general hospital. This plan covers 100 days per cause Occupational, physical, speech and language therapies Ambulance¹ YOU PAY $250 Copayment Medically necessary ground or air medical transportation Transportation NOT COVERED Non-medical transportation is not a covered service. Foot Care (podiatry services) YOU PAY $45 Copayment Foot exams and treatment if you have diabetes-related nerve damage and/or meet certain conditions Durable medical equipment 1 YOU PAY 20% Coinsurance Includes wheelchairs, oxygen, etc Fitness Center Membership YOU PAY $0 If member does not reside within 15 miles of a FirstHealth Health & Fitness Facility, member can be reimbursed up to $300 per yr for fees for FCC approved fitness facility Medicare Part B Drugs YOU PAY 20% Coinsurance Cardiac Rehabilitation YOU PAY $0 Cardiac (heart) rehab services (for a maximum of 2 one-hour sessions per day for up to 36 sessions up to 36 weeks) Chiropractic Care YOU PAY $20 Copayment Manipulation of the spine to correct a subluxation (when 1 or more of the bones of your spine move out of position) Diabetes Supplies and Services YOU PAY $0 if purchased at Diabetes monitoring supplies pharmacy or 20% Coinsurance if purchased from other supplier YOU PAY $0 Diabetes self-management training YOU PAY 20% Coinsurance Therapeutic shoes or inserts Dialysis YOU PAY 20% Coinsurance Home Health Care YOU PAY 15% Coinsurance

18 Outpatient Surgery YOU PAY $200 Copayment Ambulatory or outpatient hospital One copayment for bilateral cataract surgery if both performed in same calendar year Prosthetic devices (braces, artificial limbs, etc) 1 YOU PAY 20% Coinsurance And related medical supplies SUPPLEMENTAL BENEFITS Routine Eye Exam YOU PAY $50 Copayment $100 annual limit Annual Physical Exam YOU PAY $0 TIERS STANDARD RETAIL COST- SHARING Tier 1 (Preferred Generic) YOU PAY $6 YOU PAY $6 Tier 2 (Generic) YOU PAY $20 YOU PAY $20 Tier 3 (Preferred Brand) YOU PAY $45 YOU PAY $45 Tier 4 (Non-Preferred Brand) YOU PAY $90 YOU PAY $90 STANDARD MAIL ORDER COST- SHARING Tier 5 (Specialty) YOU PAY 33% of the cost YOU PAY 33% of the cost TIERS PRESCRIPTION DRUGS One month (30 day) supply dispensed STANDARD RETAIL COST- SHARING Two month (60 day) supply dispensed Tier 1 (Preferred Generic) YOU PAY $12 YOU PAY $0 Tier 2 (Generic) YOU PAY $40 YOU PAY $40 Tier 3 (Preferred Brand) YOU PAY $90 YOU PAY $90 Tier 4 (Non-Preferred Brand) YOU PAY $180 YOU PAY $180 Tier 5 (Specialty) Not Offered Not Offered Long Term (90 day) supply dispensed Tier 1 (Preferred Generic) YOU PAY $18 YOU PAY $0 Tier 2 (Generic) YOU PAY $60 YOU PAY $50 Tier 3 (Preferred Brand) YOU PAY $135 YOU PAY $ Tier 4 (Non-Preferred Brand) YOU PAY $270 YOU PAY $225 Tier 5 (Specialty) Not Offered Not Offered Cost-sharing may change depending when you enter another phase of the Part D please call us or access our Evidence of Coverage, Chapter 6, at our website benefit. For more information on the phases of drug coverage, STANDARD MAIL ORDER COST- SHARING

19 For more information, if you are a member, please call Member Services toll free at (TTY users call 711). If you are not a member call us toll free at From October 1 to February 14, you can call 7 days a week from 8:00 a.m. to 8:00 p.m. Eastern. From February 15 to September 30, you can call Monday through Friday from 8:00 a.m. to 8:00 p.m. Eastern. Or you can visit us at You can search our plan s provider and pharmacy directories on our website at We cover Part D drugs. In addition we cover Part B drugs such as chemotherapy and some drugs administered by your provider. You can see the complete plan formulary (list of Part D prescription drugs) and any restrictions on our website at More information about your options under Medicare is available through the Medicare publication, Medicare and You. You can get it at the Medicare website or by calling MEDICARE ( ), 24 hours a day, 7 days a week. TTY users should call

20

21 2017 Summary of Benefits FirstMedicareDirect PPO Plus (PPO) H This is a summary of drug and health services covered by FirstMedicare Direct PPO Plus January 1, December 31, 2017 The benefit information provided is a summary of what we cover and what you pay. It does not list every service that we cover or list every limitation or exclusion. To get a complete list of services we cover, please request the Evidence of Coverage. To join FirstMedicare Direct PPO Plus you must be entitled to Medicare Part A, be enrolled in Medicare Part B, and live in our service area. Our service area includes the following counties in North Carolina: Chatham, Hoke, Lee, Montgomery, Moore, Richmond, Scotland. FirstMedicare Direct PPO Plus has a network of doctors, hospitals, pharmacies, and other providers. If you use providers that are not in our network, your share of cost may be higher than if you use network providers. FirstCarolinaCare Insurance Company's FirstMedicare Direct plans are HMO and PPO health plans with a Medicare contract. Enrollment in FirstMedicare Direct depends on contract renewal. H8064_17_109 Accepted 08/23/2016

22 PREMIUM and BENEFITS Monthly Plan Premium Deductible Maximum Out of Pocket OUT OF IN NETWORK NETWORK You pay $65 $3,400 in network annually Inpatient Hospital Care YOU PAY $275 Copayment per day for days 1 through 6; YOU PAY $0 for days 7 through 90 Doctor Visits Primary Care YOU PAY $25 Copayment Specialist YOU PAY $45 Copayment Preventive Care Emergency Care Worldwide Emergency Coverage Urgently Needed Services FirstMedicare Direct PPO Plus You pay nothing $5,100 in and out of network combined annually SERVICES WITH A 1 MAY REQUIRE PRIOR AUTHORIZATION. YOU PAY 20% Coinsurance YOU PAY 20% Coinsurance YOU PAY 20% Coinsurance YOU PAY $0 YOU PAY $75 Copayment YOU PAY $30 Copayment WHAT YOU SHOULD KNOW You must continue to pay your Medicare Part B premium. This plan does not have a deductible. The most you pay for copayments, coinsurance, and other costs of medical services for the year. The copays for hospital and skilled nursing facility (SNF) benefits are based on benefit periods as defined by Medicare. Includes but not limited to: bone mass measurement; mammogram; cardiovascular screenings; cervical/vaginal screening; diabetes screening; PSA; vaccinations; annual wellness Copayment is waived if admitted within 48 hours. $10,000 lifetime limit for worldwide emergency coverage Diagnostic Tests, Lab, Therapeutic Radiology Services and X-rays YOU PAY 20% Coinsurance Hearing Services YOU PAY $45 Copayment Dental Services YOU PAY $45 Copayment Vision Services YOU PAY 30% Coinsurance YOU PAY 20% Coinsurance YOU PAY 20% Coinsurance Such as MRIs, CT scans, outpatient x-rays Exam to diagnose and treat hearing and balance issues Limited dental services (this does not include services in connection with care, treatment, filling, removal, or replacement of teeth)

23 Medicare Covered Eye Exam YOU PAY $45 Copayment YOU PAY 20% Coinsurance Medicare Covered Annual YOU PAY $0 YOU PAY 20% Glaucoma Test Coinsurance Post Cataract Surgery YOU PAY 20% YOU PAY 20% Eyewear Coinsurance Coinsurance Outpatient Mental Health YOU PAY $40 YOU PAY 20% Services Copayment Coinsurance Inpatient Mental Health YOU PAY $275 YOU PAY 20% Copayment per day Coinsurance for days 1 through 6; YOU PAY $0 for days 7 through 90 Skilled Nursing Facility YOU PAY $0 YOU PAY 20% (SNF) 1 Copayment per day Coinsurance for days 1 through 20 Outpatient Rehabilitation Services YOU PAY $150 Copayment per day for days 21 through 100 YOU PAY $40 Copayment YOU PAY 20% Coinsurance YOU PAY 20% Coinsurance Diagnose and treat diseases and conditions of the eye Group or individual therapy visits Covers up to 190 days in a lifetime in a psychiatric hospital. This limit does not apply to inpatient mental services provided in a general hospital. This plan covers 100 days per cause Occupational, physical, speech and language therapies Ambulance¹ YOU PAY $250 Copayment YOU PAY $250 Copayment Medically necessary ground or air medical transportation Transportation (non-medical) NOT COVERED NOT COVERED Non-medical transportation is not a covered service. Foot Care (podiatry services) YOU PAY $45 Copayment YOU PAY 20% Coinsurance Foot exams and treatment if you have diabetes-related nerve Durable medical equipment YOU PAY 20% and supplies 1 Coinsurance Fitness Center Membership Medicare Part B Drugs YOU PAY 20% Coinsurance YOU PAY 20% Coinsurance YOU PAY $0 YOU PAY 20% Coinsurance Cardiac Rehabilitation YOU PAY $0 YOU PAY 20% Coinsurance Includes wheelchairs, oxygen, etc. If member does not reside within 15 miles of a FirstHealth Health & Fitness Facility, you may be reimbursed up to $300 per yr for dues for an FCC approved fitness facility Cardiac (heart) rehab services (for a maximum of 2 one-hour sessions per day for up to 36 sessions up to 36 weeks)

24 Chiropractic Care YOU PAY $20 Copayment Diabetes Supplies and Services YOU PAY $0 if purchased at pharmacy or 20% Coinsurance if purchased from other supplier YOU PAY $0 YOU PAY 20% Coinsurance YOU PAY 20% Coinsurance YOU PAY 20% Coinsurance YOU PAY 20% Coinsurance YOU PAY 20% Coinsurance Manipulation of the spine to correct a subluxation (when 1 or more of the bones of your spine move out of position) Diabetes monitoring supplies Diabetes self-management training Therapeutic shoes or inserts Dialysis YOU PAY 20% Coinsurance Home Health Care YOU PAY 15% Coinsurance Outpatient Surgery YOU PAY $200 Copayment Prosthetic devices (braces, 1 YOU PAY 20% Coinsurance YOU PAY 15% Coinsurance YOU PAY 20% Coinsurance YOU PAY 20% YOU PAY 20% C i C i SUPPLEMENTAL BENEFITS Routine Eye Exam YOU PAY $50 Copayment YOU PAY 20% Coinsurance Annual Physical Exam YOU PAY $0 YOU PAY 20% Coinsurance TIERS PRESCRIPTION DRUGS STANDARD RETAIL COST- SHARING One month (30 day) supply dispensed STANDARD MAIL ORDER COST- SHARING Tier 1 (Preferred Generic) YOU PAY $7 YOU PAY $7 Tier 2 (Generic) YOU PAY $20 YOU PAY $20 Tier 3 (Preferred Brand) YOU PAY $45 YOU PAY $45 Tier 4 (Non-Preferred Brand) YOU PAY $90 YOU PAY $90 Tier 5 (Specialty) YOU PAY 33% of YOU PAY 33% of the cost the cost Two month (60 day) supply dispensed Tier 1 (Preferred Generic) YOU PAY $14 YOU PAY $0 Ambulatory or outpatient hospital One copayment for bilateral cataract surgery if both performed in same calendar year $100 annual limit Cost-sharing may change depending when you enter another phase of the Part D benefit. For more information on the phases of drug coverage, please call us or access our Evidence of Coverage, Chapter 6, at our website

25 Tier 2 (Generic) YOU PAY $40 YOU PAY $40 Tier 3 (Preferred Brand) YOU PAY $90 YOU PAY $90 Tier 4 (Non-Preferred Brand) YOU PAY $180 YOU PAY $180 Tier 5 (Specialty) Not Offered Not Offered Long Term (90 day) supply dispensed Tier 1 (Preferred Generic) YOU PAY $21 YOU PAY $0 Tier 2 (Generic) YOU PAY $60 YOU PAY $50 Tier 3 (Preferred Brand) YOU PAY $135 YOU PAY $ Tier 4 (Non-Preferred Brand) YOU PAY $270 YOU PAY $225 Tier 5 (Specialty) Not Offered Not Offered

26 For more information, if you are a member, please call Member Services toll free at (TTY users call 711). If you are not a member call us toll free at From October 1 to February 14, you can call 7 days a week from 8:00 a.m. to 8:00 p.m. Eastern. From February 15 to September 30, you can call Monday through Friday from 8:00 a.m. to 8:00 p.m. Eastern. Or you can visit us at You can search our plan s provider and pharmacy directories on our website at We cover Part D drugs. In addition we cover Part B drugs such as chemotherapy and some drugs administered by your provider. You can see the complete plan formulary (list of Part D prescription drugs) and any restrictions on our website at Out-of-network/non-contracted providers are under no obligation to treat Plan members, except in emergency situations. For a decision about whether we will cover an out-of-network service, we encourage you or your provider to ask us for a pre-service organization determination before you receive the service. Please call our customer service number or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services. More information about your options under Medicare is available through the Medicare publication, Medicare and You. You can get it at the Medicare website or by calling MEDICARE ( ), 24 hours a day, 7 days a week. TTY users should call

27 NURSE ADVICE LINE All FirstMedicare Direct members have access to the Nurse Advice Line to get health care information 24 hours a day, 7 days a week. Specially trained nurses help you when you have questions about health concerns or need health information. The nurse advice line is available at no cost. The Nurse Advice Line can help you decide what kind of care to seek. You might be able to treat the condition at home, you might need to see your doctor, or you might need to get urgent or immediate care. When you enroll, the toll free Nurse Advise Line will be on the back of your FirstMedicare Direct identification card. Just another way we care about your health.

28 ENROLLMENT QUICK REFERENCE GUIDE To start your enrollment application, you will need: 1. Your Medicare card the application requires you to enter your Medicare claim number and your Part A and Part B effective dates 2. Your list of medications so you can check the enclosed drug listing to make sure your medications are covered by us 3. Your primary care physician s name How to enroll: To enroll by phone - call toll-free at Hearing impaired persons call TTY 711. Hours are 8 am 8 pm Eastern, 7 days a week between October 1 and February 14, and from 8 am-8 pm Eastern, Monday-Friday, between February 15 and September 30. To enroll by mail -- send the enclosed enrollment form to: FirstMedicare Direct 42 Memorial Drive Pinehurst, NC To enroll online go to and click on Enroll Now Note: Medicare beneficiaries may also enroll in FirstMedicare Direct through the CMS Medicare Online Enrollment Center located at

29 NETWORK PRIMARY CARE PROVIDERS The next pages are a partial listing of Primary Care Providers (PCPs) in the FirstMedicare Direct network in the following counties: Chatham, Hoke, Lee, Montgomery, Moore, Richmond and Scotland. This list is accurate as of the time of printing. The provider network may change at any time. You will receive notice when necessary. For a complete listing, you may request a print provider directory by calling Member Services at or TTY 711. We are available for phone calls from 8 a.m. 8 p.m. Eastern, 7 days a week between October 1 and February 14, and from 8 a.m. -8 p.m. Eastern, Monday-Friday, between February 15 and September 30. You also may complete an online provider directory request form at and a print directory will be mailed to your home. To access a searchable online provider directory: 1. Visit 2. Select the Option I am a Member 3. Choose Find a Provider to search for network providers by name, location and specialty If you need help finding a network provider, please call the toll free number above.

30 Participating Primary Care Providers (PCPs) Partial Listing County Provider Specialty Status Chatham Gary N Asher, MD Family Medicine Chatham Valerie J Barnwell, MD Family Medicine Chatham Amir H Barzin, DO Family Medicine Chatham Wanda J Boggs, FNP Family Medicine Chatham William S Boyd, PAC Family Medicine Chatham Margaret Brewer, NP Internal Medicine Chatham Mallory McLester Brown, MD Family Medicine Chatham Michael S Buebel, MD Family Medicine Chatham Woodward Burgert, MD Family Medicine Chatham Wilbur B Carter, Jr, MD Family Medicine Chatham Mary K Cirigliano, DO Family Medicine Chatham Candice P Clark, FNP Internal Medicine Chatham Ann M Collins, PA Family Medicine Chatham John D Corey, MD Family Medicine Chatham Savannah N Crites, MD Family Medicine Chatham James W Davis, MD Family Medicine Chatham Hannah J Dodson, FNP Family Medicine Chatham Emily K Dolleschel, NP Family Medicine Chatham Christina M Drostin, MD Family Medicine Chatham Joan East, MD Family Medicine Chatham Dawn A Erikson, FNP Family Medicine Chatham Deborah M Esteves, MD Internal Medicine Chatham Aaron T Freuler, PAC Family Medicine Chatham David E Gibson, MD Family Medicine Chatham Mark D Gwynne, DO Family Medicine Chatham Karen D Halpert, MD Family Medicine Chatham Andrew C Hannapel, MD Family Medicine Chatham Franklin Hargett, MD Urgent Care Medicine Chatham Laura A Hester, MD Family Medicine Chatham Bryon J Hoffman, MD Internal Medicine Chatham Mary T Holmes, NP Family Medicine Chatham Mary T Holmes, NP Family Medicine Chatham James B Holt, MD Geriatric Medicine Chatham Laura K House, MD Family Medicine Chatham Cynthia C Julich, FNP Family Medicine Chatham Haresh M Kathard, MD Family Medicine Chatham Alexander Kaysin, MD Family Medicine Chatham Thomas F Koonce, MD Family Medicine Chatham Mimi Miles, MD Family Medicine Chatham Lliana A Neumann, MD Family Medicine Chatham Dana M Neutze, MD Family Medicine Chatham Matthew D Oettinger, MD Family Medicine Chatham Nathalie Ortiz Pate, PA-C Family Medicine Chatham Stephen M Pacini, PA-C Family Medicine Y0094_17_08 *This provider is currently not accepting new Medicare/Medicaid patients or other new patients.

31 Chatham Andy Phung, DO Family Medicine Chatham Ronald J Powell, MD Urgent Care Medicine Chatham Marshall E Putnam, PA-C Urgent Care Medicine Chatham Vinay C Reddy, MD Family Medicine Chatham Ashley M Rietz, MD Family Medicine Chatham Barry Saunders, MD Family Medicine Chatham Sangeeta Sawhney, MD Internal Medicine Chatham Philip D Sloane, MD Family Medicine Chatham Donna C Smith, FNP Family Medicine Chatham Brenda L Spach, FNP Geriatric Medicine Chatham Linda Marie Stiebris, PA Family Medicine Chatham Anthony J Viera, MD Family Medicine Chatham Kia J Williams, MD Family Medicine Chatham Amelia P Wilson, MD Family Medicine Chatham Erik S Butler, DO Family Medicine Chatham Wilbur B Carter, Jr, MD Family Medicine Chatham Joan East, MD Family Medicine Chatham Bryon J Hoffman, MD Internal Medicine Chatham Levonne G Powell-Tillman, MD Internal Medicine Hoke Jolena B Allred, FNP Family Medicine Hoke Tabitha M Bedini, MD Family Medicine Hoke Betty Lou B Bradley, MD Family Medicine Hoke Allen Brown, PA Family Medicine Hoke Maria C. Castillo-Powell, PAC Family Medicine Hoke Warren Thomas Day, FNP Family Medicine Hoke Rebekah B. Diky, PAC Family Medicine Hoke Vickie L Farmer, PA-C Family Medicine Hoke Kathleen V. Figler, NP Family Medicine Hoke Amy G. Gaweda, FNP Family Medicine Hoke Daniel C Hall, MD Family Medicine Hoke Alyssa C. Herron, PAC Family Medicine Hoke Sara K Hoover, MPAC Family Medicine Hoke Linda K Hughes, MD Family Medicine Hoke James R. Liffrig, MD Family Medicine Hoke Garnett Marcus Lowry, MD Family Medicine Hoke Christopher T McLaren, PAC Family Medicine Hoke Deborah L Morris, MD Family Medicine Hoke Mary Kathryn Newell, PAC Family Medicine Hoke Todd R Nicholson, PAC Family Medicine Hoke Michael D Nissen, FNP Internal Medicine Hoke Eugene B Nor, MD Family Medicine Hoke James W Shaffer, PAC Family Medicine Hoke Karen L Smith, MD Family Medicine Hoke James B Taylor, PA Family Medicine Hoke Robert L Thomas, MPAC Family Medicine Hoke Robert G Townsend, III, DO Family Medicine Hoke Rhonda S Lowry, MD Family Medicine Y0094_17_08 *This provider is currently not accepting new Medicare/Medicaid patients or other new patients.

32 Lee Ajay K Ajmani, MD Internal Medicine Lee Chamain D Austin, MD Internal Medicine Lee Parinaz Baradaran, MD Internal Medicine Lee Martin J Berger, MD Family Medicine Lee Alfred S Bunao, MD Family Medicine Lee Jessica W Burgert, MD Family Medicine Lee Erik S Butler, DO Family Medicine Lee Sally J Chapin, FNP Family Medicine Lee Dawn A Erikson, FNP Family Medicine Lee Deborah M Esteves, MD Internal Medicine Lee Charles A Eure, MD Internal Medicine Lee Kim A Finlay-Tozzi, DO Internal Medicine Lee Dana L Garrett, MD Family Medicine Lee William E Hall, MD Family Medicine Lee Franklin Hargett, MD Urgent Care Medicine Lee Russell Harrell, MD Family Medicine Lee Michele I Hensley, MD Family Medicine Lee James B Holt, MD Geriatric Medicine Lee Jill J Lambert, MD Family Medicine Lee Sameer M Maroof, DO Family Medicine Lee Parker S McConville, MD Family Medicine Lee Robert H McConville, MD Family Medicine Lee Steven P Michael, DO Internal Medicine Lee Gerard J O'Donnell, MD Internal Medicine Lee June L Peck, FNP Family Medicine Lee Jaime Pedraza, MD Family Medicine Lee Ronald J Powell, MD Urgent Care Medicine Lee Marshall E Putnam, PA-C Urgent Care Medicine Lee Pavan Pyreddy, MD Internal Medicine Lee Namrata M Shidhaye, MD Family Medicine Lee Beth P Stanfield, FNP Family Medicine Lee Robert L Thomas, MPAC Family Medicine Lee Cheyanna L Trujillo, FNP Family Medicine Lee Mary R Varghese, MD Internal Medicine Lee Andrea M Vice, MD Family Medicine Lee John M Woodyear, Jr, MD Family Medicine Lee Daniel P Woydick, MD Family Medicine Lee Glenna L Grider, MD Internal Medicine * Lee Cynthia C Julich, FNP Family Medicine Lee John R Mangum, MD Family Medicine * Lee Vaishali R Nadkarni, MD Family Medicine * Lee Lester D Nave, Jr, MD Family Medicine * Lee Jennifer B Normann, MD Internal Medicine * Lee Mohini Pandiri, MD Internal Medicine Lee Murali D Pisharody, MD Family Medicine * Montgomery Jolena B Allred, FNP Family Medicine Montgomery Betty Lou B Bradley, MD Family Medicine Y0094_17_08 *This provider is currently not accepting new Medicare/Medicaid patients or other new patients.

33 Montgomery Taressa Aliene Bryan, FNP Family Medicine Montgomery David N Buckland, PAC Family Medicine Montgomery Chrystal F Eller, MD Family Medicine * Montgomery Carolyn E Green, PA-C Family Medicine Montgomery Sara K Hoover, MPAC Family Medicine Montgomery Janet Ann Leone-Britt, PAC Family Medicine Montgomery James R. Liffrig, MD Family Medicine Montgomery Kimberley Sierra Lingler, MD Family Medicine Montgomery Johnnie D Lyles, MD Family Medicine Montgomery Eugene B Nor, MD Family Medicine Montgomery Touber Vang, MD Family Medicine Montgomery John M Woodyear, Jr, MD Family Medicine Montgomery James R. Liffrig, MD Family Medicine Moore Jeffrey N Binney, MD Internal Medicine * Moore Michael B Daley, MD Internal Medicine * Moore Robert L Deucher, MD Internal Medicine Moore Rebekah B. Diky, PAC Family Medicine Moore Jolena B Allred, FNP Family Medicine Moore Michael A Antil, MD Internal Medicine Moore Marcia H Ballard, FNP Family Medicine Moore Aemonn T Barnes, FNP Family Medicine Moore Diedre M. Bass, PAC Family Medicine Moore Julie G Baugher, MD Internal Medicine Moore William L Bell, MD Family Medicine Moore Greg M Blakely, MD Internal Medicine Moore Kristy R Boan, PAC Internal Medicine Moore Marri K. Brackman, DO Family Medicine Moore Betty Lou B Bradley, MD Family Medicine Moore Maria C. Castillo-Powell, PAC Family Medicine Moore Lauren B Chriscoe, ANP Internal Medicine Moore Pamela Sue Christaldi, ANP Internal Medicine Moore William Cuza, FNP Family Medicine Moore Robert L Deucher, MD Internal Medicine Moore George D Edenfield, Sr, PAC Internal Medicine Moore Chrystal F Eller, MD Family Medicine * Moore Shawana A Faulk, FNP Family Medicine Moore Sofia Filzer, PA-C Family Medicine Moore Jackson V Gibson, MD Internal Medicine Moore Carolyn E Green, PA-C Family Medicine Moore Daniel C Hall, MD Family Medicine Moore Russell Harrell, MD Family Medicine Moore Janine B Hepler, FNP Family Medicine Moore Alyssa C. Herron, PAC Family Medicine Moore David E Hipp, MD Internal Medicine Moore Sara K Hoover, MPAC Family Medicine Moore Angie F Hounsell, FNP Family Medicine Moore John W Jameson, III, MD Family Medicine * Y0094_17_08 *This provider is currently not accepting new Medicare/Medicaid patients or other new patients.

34 Moore Jeffrey J Kern, MPAC Family Medicine Moore Kathy L Kirchner, ANP Internal Medicine Moore Douglas E Lam, MD Family Medicine * Moore Thomas R Leonard, MD Family Medicine Moore Kathleen A Letizia, MD Internal Medicine Moore James R. Liffrig, MD Family Medicine Moore Thomas H Lineberger, MD Internal Medicine * Moore Garnett Marcus Lowry, MD Family Medicine Moore Stacy L Marcum, PA-C Internal Medicine Moore Amanda H Martin, ANP Family Medicine Moore Bobby R Maynor, Jr, MD Internal Medicine * Moore Christine A McBride, PAC Family Medicine Moore Christopher T McLaren, PAC Family Medicine Moore Randall Robert Mercier, MD Internal Medicine Moore Deanna L Mills, ANP Family Medicine Moore Philip G Mondi, MD Internal Medicine Moore Walter S Morris, III, MD Internal Medicine Moore Leslie C Murphy, MD Internal Medicine Moore Todd R Nicholson, PAC Family Medicine Moore Bobbie E Norris, NP Internal Medicine Moore Francesco R Olivito, DO Family Medicine Moore Kathleen H Prussian, FNP Family Medicine Moore Cheryl R Rachels, FNP Internal Medicine * Moore Fabian D Rodriguez, MD Internal Medicine Moore Jeffery P Short, PAC Family Medicine Moore Michol Stanzione, DO Internal Medicine Moore Jennifer G Szurgot, MD Internal Medicine Moore Julie M Thomas, MPAC Internal Medicine Moore Robert L Thomas, MPAC Family Medicine Moore Padiwath C Ung, MD Internal Medicine Moore Joy H Vonk, PAC Family Medicine Moore Ronald D Walters, MD Internal Medicine Moore Thomas L Wilkins, PAC Family Medicine Moore Sondra N Williamson, ANP Internal Medicine Moore Harvey H Wolf, MD Internal Medicine Moore John M Woodyear, Jr, MD Family Medicine Moore James W Shaffer, PAC Family Medicine Richmond Rebekah B. Diky, PAC Family Medicine Richmond Jolena B Allred, FNP Family Medicine Richmond Gilbert D Arenas, MD Family Medicine Richmond Diedre M. Bass, PAC Family Medicine Richmond Kristy R Boan, PAC Internal Medicine Richmond Melva R Bowman, MD Family Medicine Richmond Diane L Brown, NP Family Medicine Richmond Johnny E Camargo, MD Internal Medicine Richmond Maria C. Castillo-Powell, PAC Family Medicine Richmond William Cuza, FNP Family Medicine Y0094_17_08 *This provider is currently not accepting new Medicare/Medicaid patients or other new patients.

35 Richmond Christina Kirkley Dixon, ANP Internal Medicine Richmond David H Emmons, FNP Family Medicine Richmond Sofia Filzer, PA-C Family Medicine Richmond John E Flannery, MD Internal Medicine Richmond Daniel C Hall, MD Family Medicine Richmond Alyssa C. Herron, PAC Family Medicine Richmond Sara K Hoover, MPAC Family Medicine Richmond Stephen S. Kapa, MPAC Family Medicine Richmond Jeffrey J Kern, MPAC Family Medicine Richmond Bohdan W Kopynec, MD Family Medicine Richmond James R. Liffrig, MD Family Medicine Richmond Garnett Marcus Lowry, MD Family Medicine Richmond Charlita R Mangrum, MD Family Medicine Richmond Venkata S Mannava, MD Internal Medicine Richmond Cynthia W McLemore, MD Family Medicine Richmond Fred D McQueen, Jr, MD Family Medicine Richmond Steven D Millen, ANP Family Medicine Richmond Luiz Nascimento, MD Internal Medicine Richmond Todd R Nicholson, PAC Family Medicine Richmond Shilpesh P Patel, MD Internal Medicine Richmond Emily N Phillips, MPAC Internal Medicine Richmond Gleybis Sanchez Lobaina, MD Internal Medicine Richmond Janet L Sanford, FNP Family Medicine Richmond Julie M Thomas, MPAC Internal Medicine Richmond Robert L Thomas, MPAC Family Medicine Richmond Bridget N Thompson, PAC Family Medicine Richmond Patsy C Webb, NP Family Medicine Richmond Cindy B White, FNP Internal Medicine Richmond Thomas L Wilkins, PAC Family Medicine Richmond Dierdre T Young-Cadore, MD Internal Medicine Richmond Gleybis Sanchez Lobaina, MD Internal Medicine Richmond James W Shaffer, PAC Family Medicine Scotland Frank J Ball, Jr, MD Internal Medicine Scotland Jaclyn W Bates, PA-C Family Medicine Scotland Dixie L Bhiro, PA Family Medicine Scotland Thakurdeo M Bhiro, PA Family Medicine Scotland Katherine T Blackmon, FNP Urgent Care Medicine Scotland Lisa E Bracey, MD Family Medicine Scotland Terri B Cowan, PA-C Family Medicine Scotland James M Cox, PA Family Medicine Scotland Anna M Duncan, DO Family Medicine Scotland Mary J Elam, PA Family Medicine Scotland David C Estabillo, FNP Family Medicine Scotland Tonya E Eteo, FNP Family Medicine Scotland Bradford K Faulkenberry, MD Family Medicine Scotland Mary R Forgach, PA-C Urgent Care Medicine Scotland Jennifer D Fralix, PA Family Medicine Y0094_17_08 *This provider is currently not accepting new Medicare/Medicaid patients or other new patients.

36 Scotland Sarah D Gainey, PA Urgent Care Medicine Scotland Donna E Gibson, FNP Family Medicine Scotland David A Goff, MD Internal Medicine Scotland Glenn R Harris, MD Family Medicine Scotland David A Howell, MD Family Medicine Scotland Patrick Scott Hurley, PAC Urgent Care Medicine Scotland Muhammad Jawad Iqbal, MD Internal Medicine Scotland Charles Edward Jackson, FNP Family Medicine Scotland Ashley M Locklear, PA Family Medicine Scotland Jennifer P Locklear, MD Family Medicine Scotland Jadene Lowry, MD Family Medicine Scotland Kimberly A Major, PA-C Family Medicine Scotland Matthew T Manzo, DO Family Medicine Scotland Carmella C Marshall, PA Family Medicine Scotland Leanne M Mays, PA-C Family Medicine Scotland Mary C Moree, MD Family Medicine Scotland LuAnne C Murphy, FNP Internal Medicine Scotland Satoya Murray, FNP Family Medicine Scotland Musharraf Navaid, MD Internal Medicine Scotland John W Neal, MD Family Medicine Scotland Mary A Newton, FNP Family Medicine Scotland Eugene B Nor, MD Family Medicine Scotland Leslie K Oxendine, FNP Family Medicine Scotland Keith S Rockwiley, PA-C Urgent Care Medicine Scotland Jonathan D Rowson, MD Family Medicine Scotland Matthew B Thompson, MSN, FNP Family Medicine Scotland Habiba Tunau, MD Internal Medicine Scotland James J Ventrilla, PA Family Medicine Scotland Cindy B White, FNP Internal Medicine Scotland Richard C Wolonick, DO Family Medicine This list of Primary Care Providers (PCPs) is for Chatham, Hoke, Lee, Montgomery, Moore, Richmond and Scotland Counties. This directory provides a partial list of primary care providers in the FirstMedicare Direct network. For a complete listing, please call and TTY 711 or visit We are available for phone calls from 8am 8pm Eastern 7 days a week between October 1 and February 14, and from 8am-8pm Eastern Monday through Friday between February 15 and September 30. This listing is current as of 8/01/2016. Some network providers may have been added or removed from our network after this directory was printed. We do not guarantee that each provider is still accepting new members. Other physicians and providers are available in our network. Y0094_17_08 *This provider is currently not accepting new Medicare/Medicaid patients or other new patients.

37 Pharmacy Chain Name Website Toll Free Number TTY/ TDD Choice 90 WALGREENS Y DUANE READE Y RITE AID Y FRED'S Y TARGET =pharmacy_landing Y CVS Y CARE PLUS/CVS Y WALMART Y KROGER Y RALPH'S Y FRY'S FOOD AND DRUG Y FRED MEYER Y SMITHS Y KMART mart+pharmacy+microsite Y PUBLIX Y SAFEWAY Y VONS/PAVILLION Y CARRS/EAGLE Y COSTCO ctno= Y WINN-DIXIE Y STOP AND SHOP dex.htm Y ALBERTSONS Y JEWEL/OSCO Action.action Y SAVON Y CUB Y SHOPPER'S Y SHOP AND SAVE Y FARM FRESH Y GIANT EAGLE Y Y0094_17_011 CMS Approved 08/17/2017