Frequently Asked Questions
How can I compare my options?
You can compare us and the Original Medicare Plan using this Summary of Benefits. The charts in this booklet list some important health benefits. For each benefit, you can see what our plan covers and what the Original Medicare Plan covers. Our members receive all of the benefits that the Original Medicare Plan offers. We also offer more benefits, which may change from year to year.
Where are we available?
The service area for this plan includes the following counties in Arizona: Cochise, Gila, Graham, Greenlee, La Paz, Maricopa, Pima, Pinal, Santa Cruz, Yavapai, and Yuma. You must live in one of these areas to join the plan. If you move to a county that is not listed above, please call our Customer Care Center to find out if University Care Advantage has a plan in your new county.
*Effective 1/01/2019: Yavapai will no longer be part of our service area.
Who is eligible to join?
You can join Banner – University Care Advantage (HMO SNP) plan if you are entitled to Medicare Part A and enrolled in Medicare Part B and live in the service area. However, individuals with End-Stage Renal Disease generally are not eligible to enroll with us, unless they are members of our organization and have been since their dialysis began. You must also be enrolled with the Arizona Health Care Cost Containment System (AHCCCS). Please call the plan to see if you are eligible to join.
Can I choose my doctors/providers?
Banner – University Care Advantage has formed a network of doctors, specialists, and hospitals. You can only use doctors or providers who are part of our network. The health providers in our network can change at any time.
What happens if I go to a provider who is not in my network?
If you choose to go to a provider outside of Banner – University Care Advantage's network, you must pay for these services yourself except in limited situations (for example, emergency care). Neither the plan nor the Original Medicare Plan will pay for these services.
Does my plan cover Medicare Part B or Part D drugs?
Banner – University Care Advantage does cover both Medicare Part B prescription drugs and Medicare Part D prescription drugs.
Where can I get my prescriptions if I join this plan?
Banner – University Care Advantage has formed a network of pharmacies. You must use a network pharmacy to receive plan benefits. We may not pay for your prescriptions if you use an out-of-network pharmacy, except in certain cases. The pharmacies in our network can change at any time. You can ask for a current Provider and Pharmacy Directory.
What is a Prescription Drug Formulary?
Banner – University Care Advantage uses a drug formulary. A drug formulary is a list of drugs covered by your plan to meet patients' needs. We may periodically add, remove, or make changes to coverage limitations on certain drugs or change how much you pay for a drug. If we make any formulary change that limits our members' ability to fill their prescriptions, we will notify the affected enrollees before the change is made. We will send a formulary to you and you can see our complete formulary on our Website. If you are currently taking a drug that is not on our formulary or subject to additional requirement or limits, you may be able to get a temporary supply of the drug. You can contact us to request an exception or switch to an alternative drug listed on our formulary with your physician's help. Call us to see if you can get a temporary supply of the drug or for more details about our drug transition policy.
How can I get extra help with my prescription drug plan costs or get extra help with other Medicare costs?
- 1-(800) MEDICARE (1(800) 633-4227). TTY/TDD users should call 1 (877) 486-2048, 24 hours a day/7 days a week; and see www.medicare.gov, 'Programs for People with Limited Income and Resources' in the publication Medicare & You.
- 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.
- Your State Medicaid Office at (602) 417-7000 in Maricopa County or (800) 962-6690 Outside Maricopa County.
What is a Medication Therapy Management (MTM) Program?
A Medication Therapy Management (MTM) Program is a free service we offer. You may be invited to participate in a program designed for your specific health and pharmacy needs. You may decide not to participate but it is recommended that you take full advantage of this covered service if you are selected. Contact our plan for more details.