Troy Medicare (D-SNP)

Who Can Join?

To enroll in Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP) you must be eligible for Medicare Part A and Part B and receive certain levels of assistance from the North Carolina Medical Assistance program (FBDE, SLMB Plus, QMB Plus or QMB). If you receive both Medicare and Medicaid benefits, this means you are a Dual-eligible beneficiary.

Additionally, you need to reside in one of the following counties in North Carolina: 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.

Summary of Benefits

Secure Member Portal

Our secure Troy Medicare member portal has resources to help you manage your plan with a personalized view of your health benefits. Register for 24/7 access to review plan materials, view your personal information, download forms, and more.

Evidence of Coverage

An Evidence of Coverage (EOC) is a document that provides information on the plan, providers, benefits information including what is covered and how much you as a member has to pay for those benefits, how to ask us to cover a service, how to file an appeal if we deny coverage, and how to file a grievance.

Prior Authorizations

Certain benefits require an approval in advance. When a benefit needs approval in advance, you or your provider can submit a medical coverage determination request. These benefits are marked with an asterisk in your Evidence of Coverage booklet, Chapter 4, Benefit Listing.

Referrals

Your relationship with your Primary Care Provider (PCP) is very important. Your PCP will coordinate your care and make referrals to specialists or for diagnostic services. You do not need a referral for specialist visits, but it is advised to see your PCP first to make sure you are going to the right specialist.