2023 Western North Carolina Key Things Guide

Key Things to Know

Your Membership Fact Sheet Thanks for being a FirstMedicare Direct member. We’re happy you’re here and are excited to help you use your plan and all its perks made for you.

Changes for 2023 Benefits and other aspects of a plan can change each year, even if you keep the same plan. Below are some benefit changes for the 2023 plan year.

Category

Change

Occupational Therapy and Physical & Speech Therapy

Decreased copay to $10.

Other ways you can identify plan changes: •

Review your Annual Notice of Change (ANOC) that is mailed to you every September, or find it at FirstMedicare.com.

•

Call Member Services at the number on the back of your ID card. We can help you with any benefit change questions you might have.

Outpatient Diagnostic Procedures Decreased outpatient diagnostic procedures, labs and tests copay to $0.

Outpatient X-Rays

Decreased copay to $0.

Hally ® Member Website

Pharmacy

Get secure, instant access to your coverage by logging in to hally.com. While you’re logged in to hally.com, you can: •

Sign up for text alerts.

Your plan comes with pharmacy coverage. Remember, the formulary (or list of drugs we cover) can change yearly. You can review it at FirstMedicare.com.

•

Go paperless by opting in for secure eDelivery of your plan materials.

Perks and Programs

•

Know where to go for care depending on your symptoms.

•

Pay your monthly premium using Premium Bill Pay and set up recurring payments.

Your plan is made with plenty of perks and programs to help you with your health goals. Go online to FirstMedicare.com/Perks to view all the options available on your plan.

•

View past and current claims, authorizations and Explanations of Benefits.

•

Find doctors, facilities and pharmacies covered by your plan.

•

Check your spending.

Your Care Options Your plan is made with plenty of options for different situations based on how severe your condition is, where you are and other factors.

For in-person coverage options, you can access our extensive provider network, from which you can select a primary care provider (PCP) to oversee your care. If your illness or injury is not an emergency, set up an appointment with your PCP.

Member Services is here to help.

If you have questions about these changes or your plan in general, call the Member Services number on the back of your ID card and have your member number ready. You’ll be prompted to make selections based on your type of question. Member Services can help with questions about eligibility, premiums, claims, prescriptions, authorizations, letters and more.

Refer to the Key Benefits Guide included with this document for information about our plan, premium, and copayment or coinsurance amounts for commonly used benefits.

Some injuries or illnesses require emergency care, but if your injury or illness doesn’t require immediate medical attention, calling your doctor or going to an urgent care clinic (sometimes called convenient care or a walk-in clinic) can save you time and money.

Always go to the emergency department (ED) or call 911 if you experience: •

Stroke symptoms.

•

Chest pains.

•

Head or spinal injuries.

•

Severely broken bones.

These are examples, not a complete list. If you think your condition is a life-threatening emergency, call 911 or go to the nearest ED.

FirstCarolinaCare Insurance Company is a health plan with a Medicare contract.

Enrollment in FirstCarolinaCare depends on contract renewal.

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