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1-888-494-8769 TTY:711
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Toll-free number
1-888-494-8769
TTY:711

Member Rights and Responsibilities

As a Medicare member of our plan, you have the right to:

  1. Be treated with respect, and not be discriminated against based on race, ethnicity, national origin, disability, religion, gender or age.
  2. We must provide information in a way that works for you (in languages other than English, in Braille, in large print, or other alternate formats, etc.)
  3. Receive timely access to network providers and prescription drugs, including emergency care services, 24 hours a day, seven days a week.
  4. Protect the privacy of your personal health information.
  5. Get information about the plan, its network of providers and your covered services.
  6. Know all your treatment options and participate fully in discussions and decisions about your health care.
  7. Refuse any treatment recommended to you by any provider.
  8. File a complaint, ask for a coverage decision, or ask us to reconsider decisions we have made.
  9. Get help if you believe you are being treated unfairly or your rights have not been respected.

As a Medicare member of our plan, you have the responsibility to:

  1. Tell your doctor and other health care providers that you are enrolled in our plan.
  2. Get familiar with your covered services and the rules you must follow to get these covered services.  
  3. Tell your doctor and other health care providers that you are enrolled in our plan.
  4. Tell us if you have any other insurance coverage or prescription drug coverage in addition to our plan.
  5. Be considerate. We expect all our members to respect the rights of other patients.
  6. Pay what you owe. Pay what you are responsible for paying, your co-pays, co-insurance, and premiums,
  7. Tell us if you move. If you move outside the plan’s service area, you cannot remain a member of our plan.
  8. Help your doctors and other providers help you by giving them the necessary information, asking questions and following through on your care.
  9. Practice preventive care by having the appropriate texts and immunizations and engaging in healthy lifestyle choices (e.g., exercise, diet).

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Want to learn more about Troy Medicare?

We are available 8am to 8pm Eastern Time
October 1 to March 31, 7 days a week
April 1 to September 30, Monday to Friday

Call us:
1-888-494-TROY (8769)
TTY:711

Member Call Center Representatives are available 8am to 8pm Eastern Time, Monday to Friday (from October 1 to March 31, 8am to 8pm Eastern Time, 7 days a week).

Toll-free number
1-888-494-TROY (8769)
TTY:711
Fax: 1-919-375-3533
Plan Information
About Us
Policies
Policies
P.O. Box 11267, Charlotte, NC 28220
Last Updated: 10.14.2023

Powered by Troy.AI © 2023 Troy Health, Inc. All Rights Reserved.

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.

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