Medical Policies

Troy Medicare is available to anyone who is eligible for Medicare Part A and Part B and resides in Alexander, Anson, Bladen, Buncombe, Burke, Caldwell, Catawba, Chatham, Columbus, Cumberland, Durham, Franklin, Granville, Harnett, Haywood, Henderson, Hoke, Iredell, Jackson, Lee, McDowell, Mitchell, Montgomery, Moore, Orange, Person, Polk, Richmond, Robeson, Sampson, Scotland, Swain, Transylvania, Vance, or Yancey counties in North Carolina.

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Plans are offered through Troy Medicare, a Medicare Advantage HMO and HMO D-SNP organization with a Medicare contract. Enrollment in these plans depends on the planʼs contract renewal with Medicare. Troy Medicare HMO D-SNP also has a contract with state Medicaid.

Benefits, formulary, provider, pharmacy network, premium and/or copayments/coinsurance may change on January 1 of each year. Member premiums, copays, coinsurance, and deductibles may vary based on the level of Extra Help you receive. Please contact the plan for further details. 

Troy does not discriminate or exclude people because of their race, color, national origin, ancestry, age, disability, ethnicity, sex, sexual orientation, gender, gender identity or expression, marital status, religion, or language.

The Formulary may change at any time. You will receive notice when necessary. 

You must generally use network pharmacies to use your prescription drug benefit.

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This information is not a complete description of benefits. Call 1-888-494-TROY (8769) (TTY 711) for more information.

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This document is available in alternative formats. If you need this document in an alternative format, call Member Service at 1-888-494-TROY (8769) (TTY:711).

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To report suspected incidents of non-compliance and/or fraud, waste or abuse, you can contact Troy Medicare directly or anonymously  in the following ways:

Reporting portal: troymedicare.ethicspoint.com
Toll-free Ethics Help Line: (844) 977-0475

Your assistance may help curtail the costs of healthcare to our members.

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Medicare beneficiaries may also enroll in Troy Medicare through the CMS Medicare Online Enrollment Center located at https://www.medicare.gov.

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ATTENTION: If you speak another language, language assistance services, free of charge, are available to you. Call 1-888-494-TROY (8769) (TTY 711).

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Troy Medicare(HMO)’s pharmacy network includes limited, lower-cost, preferred pharmacies in our service areas. You can go to all pharmacies listed in our Pharmacy Directory, but your costs for some drugs may be less at pharmacies in this list that offer preferred cost sharing. We have marked these pharmacies with "PREFERRED" under the Cost Sharing column in our Pharmacy Directory to distinguish them from other pharmacies in our network that offer standard cost sharing. An updated Pharmacy Directory can be located on our website. You may also call Troy Medicare (HMO) or Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP) Pharmacy Member Service at 1-866-423-8065 (TTY/TDD users should call 711) for updated information.