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The following counties are in the Innovation Health Medicare service area: Alexandria City, Arlington, Fairfax, Fairfax City, Falls Church City, Fredericksburg City, Loudoun, Manassas City, Manassas Park City, Prince William, Spotsylvania, Stafford

Innovation Health Medicare Connection Plan (HMO)

Evidence of Coverage (coverage details)

Evidence of Coverage (coverage details) (Spanish)

Low Income Subsidy (Extra Help paying for prescriptions)

Low Income Subsidy (Extra Help paying for prescriptions) (Spanish)

Summary of Benefits

Summary of Benefits (Spanish)

Innovation Health Medicare Voyager Plan (PPO)

Evidence of Coverage (coverage details)

Evidence of Coverage (coverage details) (Spanish)

Low Income Subsidy (Extra Help paying for prescriptions)

Low Income Subsidy (Extra Help paying for prescriptions) (Spanish)

Summary of Benefits

Summary of Benefits (Spanish)

Prescription drug coverage

See a list of covered drugs for your plan

Referrals & prior authorizations

Looking for referral and pre-approval requirements?
Check your plan’s Evidence of Coverage.

Check your claims

Review your claim and payment status

Flu shot coverage

Protect yourself from the flu.
Learn about your flu shot benefit

Medicare coverage changes

The Centers for Medicare & Medicaid Services periodically issues National Coverage Determinations. They issue these when a service’s or drug’s coverage rules change.
View a list of coverage determinations

Coverage during a disaster or emergency

We want to make sure you can access your benefits even during urgent situations - like a public health emergency or state of disaster.
Finding care during a disaster or emergency

How we decide which health care services to cover

We help you get medically necessary health care services in the most cost-effective way under your health plan. And we work with you and doctors to evaluate services for medical appropriateness, timeliness and cost.

Specifically, we:

Base our decisions on appropriateness of care, service and plan coverage
Use nationally recognized guidelines and resources to make changes
Don’t pay or reward providers, employees or others for denying coverage or care
Focus on reviewing the risks of members who aren’t fully using certain services

How we review new technologies

Doctors and health care companies continuously develop new technologies. This can include anything from a new procedure to a new way to use a device.

When we learn about a new technology, we:

Carefully review the latest information and ask experts for their opinions
Compare the information with well-known standards
Base all of our decisions on making sure you have the right care and services

Using an out-of-network provider

If you’re enrolled in a standard Innovation Health Medicare Plan (HMO)
You’ll have to choose a primary care physician (PCP).
Generally, you must get your health care coverage from your primary care physician (PCP). Your PCP will issue referrals to participating specialists and facilities for certain services. For some services, your PCP is required to obtain prior authorization from Innovation Health Medicare.
You’ll need to get a referral from your PCP for covered, non‐emergency specialty or hospital care, except in an emergency and for certain direct‐access service. There are exceptions for certain direct access services.
You must use network providers, except for:

Emergency or urgent care situations
Out‐of‐area renal dialysis

If you get routine care from out‐of‐network providers, Medicare and Innovation Health Medicare won’t be responsible for the costs.

If you’re enrolled in an Innovation Health Medicare Plan (HMO) Open Access
You’re not required to choose a primary care physician (PCP). You don’t need a referral to visit network providers to receive covered services. Although you’re not required to select a PCP, we encourage you to do so.
You must use network providers, except for:

Emergency or urgent‐care situations
Out‐of‐area renal dialysis

If you get care from an out‐of‐network provider, your plan won’t cover their charges. Medicare and Innovation Health Medicare won’t be responsible either.

If you’re enrolled in Innovation Health Medicare Plan (PPO)
You have the flexibility to receive covered services from network providers or out‐of‐network providers. Out‐of‐network/non‐contracted providers are under no obligation to treat Innovation Health Medicare members, except in emergency situations. For a decision about whether we’ll 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 us or see your Evidence of Coverage for more information, including the cost share for out‐of‐network services.
Although you don’t have to choose a primary care physician, we encourage you to do so. If you receive covered services from an out‐of-network doctor, it’s important to confirm that they:

Accept your PPO plan
Are eligible to receive Medicare payment

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Members

Find your plan information

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Innovation Health Medicare Connection Plan (HMO)

Innovation Health Medicare Voyager Plan (PPO)

Prescription drug coverage

Referrals & prior authorizations

Check your claims

Flu shot coverage

Medicare coverage changes

Coverage during a disaster or emergency

How we decide which health care services to cover

How we review new technologies

Using an out-of-network provider

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