Network Providers and Out-of-Network Coverage Rules
You can use any doctor who is part of RMHP’s network. You may also go to doctors outside of our network. We may not pay for services you receive outside of our network, but Medicare will pay for its share of charges it approves. You will be responsible for paying the Medicare deductible and coinsurance for those services, unless they were authorized in advance by RMHP.
Enrollment, Premiums, and Benefits
RMHP’s contract with Medicare is renewed annually. The availability of coverage beyond the end of the current contract year is not guaranteed. However, RMHP has contracted with Medicare to provide benefits since 1977.
Eligible beneficiaries can enroll in RMHP medical-only Cost plans at any time but can only enroll in plans that include Part D drug coverage during specific times of the year. For enrollment guidelines and full information on RMHP benefits, please call Customer Service.
Medicare beneficiaries may be enrolled in only one Part D plan at a time.
Individuals are able to enroll in RMHP if they are enrolled under Medicare Parts A and B or B only and reside in our service area.
If you decide to switch to premium withhold through Social Security or the Railroad Retirement Board, or move from premium withhold to direct bill, it could take up to three months for it take effect, and you will continue to be responsible for direct payment of premiums until the change takes effect.
For more information, call Customer Service.
Disenrollment Rights & Responsibilities
You may disenroll from an RMHP plan at any time. You may switch to Original Medicare, or, if you have a Special Enrollment Period, you may enroll in a Medicare Advantage or another Medicare prescription drug plan. To end your membership, you must make your request in writing to RMHP. Your membership will end on the last day of the month in which RMHP receives your request. You may contact RMHP if you need additional information. If you are hospitalized on the day that your membership ends, your hospital stay will usually be covered by our plan until you are discharged (even if you are discharged after your new health coverage begins). Upon disenrollment, RMHP will no longer cover any health care and/or prescription drugs for you effective on the date of disenrollment.
RMHP must end your membership in the plan if any of the following happens:
- If you do not stay continuously enrolled in Part B. Members must stay continuously enrolled Medicare Part B.
- If you move out of our service area or you are away from our service area for more than six months.
- If you continuously behave in a way that is disruptive and makes it difficult for us to provide medical care for you and other Members of our plan. (We cannot make you leave our plan for this reason unless we get permission from Medicare first.)
- If you let someone else use your membership card to get medical care. (We cannot make you leave our plan for this reason unless we get permission from Medicare first.) If we end your membership because of this reason, Medicare may have your case investigated by the Inspector General.
- If you do not pay the plan premiums.
If you are termed from RMHP, you have the right to ask RMHP to reconsider our disenrollment through the grievance process written in your Evidence of Coverage. For more information, see the chapter called "Ending Your Membership in the Plan" in the Evidence of Coverage.
Notice of Nondiscrimination & Multi-Language Interpreter Services Information
Medicare National Coverage Decisions (NCD)
From time to time, Medicare makes decisions regarding the coverage of items and services. These decisions are called Medicare National Coverage Determinations (NCD). Medicare may begin covering an item or service or change the way an item or service is covered. We want to make sure our Members have the most up-to-date information regarding NCDs.
This page was last updated: 10/01/2018. Please call to confirm you have the most up to date information about our Medicare Cost plans.
Important Disclaimers: RMHP is a Medicare-approved Cost plan. Enrollment in RMHP depends on contract renewal. This information is not a complete description of benefits. Call RMHP Customer Service at 888-282-1420 (TTY: 711) for more information. Other pharmacies, physicians, providers are available in our network. Medicare beneficiaries may also enroll in RMHP through the CMS Medicare Online Enrollment Center located at http://www.medicare.gov. For a complete list of available plans please contact 1-800-MEDICARE (TTY users should call 1-877-486-2048), 24 hours a day/7 days a week or consult www.medicare.gov. Every year, Medicare evaluates plans based on a 5-star rating system. If you need help finding a network provider, please call 888-282-1420 (TTY 711) or visit www.rmhpMedicare.org to access our online searchable directory. If you would like a provider directory mailed to you, you may call the number above, request one at the website link provided above, or email customer_service@RMHP.org.
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