Benefits & Coverage

The Summary of Benefits compares Original Medicare coverage with Capital Health Plan Retiree Advantage (HMO) coverage.

You can compare Capital Health Plan Retiree Advantage and 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 that Original Medicare offers. We also offer additional benefits, which may change from year to year.

Your Evidence of Coverage gives the details about your Medicare health coverage and explains how to get the care that you need.

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 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.

Last updated: 10/01/2011

Have questions on getting care when you travel or are away from the plan's service area? Check here for details on Capital Health Plan Retiree Advantage's out of area coverage.

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. Please click here to download the 2012 Capital Health Plan Provider and Pharmacy Directory (pdf 331.57 kB) . 

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) 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.

Cost sharing refers to premium and amounts that a member pays when services are received.  Cost sharing includes copayments and coinsurnance.