Conditions & Limitations

You have choices in your health care. As a Medicare beneficiary, you can choose from different Medicare options. One option is Original (fee-for-service) Medicare. Another option is a Medicare Advantage health plan, like Capital Health Plan Retiree Advantage (HMO). You may have other options, too. You make the choice. No matter what you decide, you are still in the Medicare Program.

You may join or leave a plan only at certain times. For more information, please call Capital Health Plan at one of the telephone numbers listed on this page or call Medicare at 1-800-MEDICARE (1-800-633-4227) for more information (TTY users should call 1-877-486-2048.) You may call Medicare 24 hours a day, 7 days a week.

Capital Health Plan Options

You can compare Capital Health Plan Retiree Advantage with Original Medicare using the Summary of Benefits. The chart in the Summary of Benefits lists important health benefits. For each benefit, you can see what our plan covers and what Original Medicare covers.

Our members receive all of the benefits Original Medicare offers. We also offer additional benefits, which may change from year to year.

Provider Network

Capital Health Plan has formed a network of doctors, specialists, and hospitals. You will use providers who are part of our network. The health providers in our network can change at any time. You can ask for a current Directory of Physicians, Service Providers & Pharmacies (pdf 1.73 MB) (pdf 1.89 MB) for an up-to-date list. You must use network providers except in emergency or urgent care situations or for out-of-area dialysis or other services. If you obtain routine care from out-of-network providers neither Medicare nor Capital Health Plan will be responsible for the costs.

Pharmacy Network

Beneficiares must use network pharmacies to access their prescription drug benefit, except in non-routine circumstances, and quantity limitations and restrictions may apply. If you go to a pharmacy that is not in our network, you might have to pay more for your prescriptions. You also might have to follow special rules before getting your prescription to have the prescription covered under our plan. For more information, call Capital Health Plan at one of the telephone numbers listed on this page.