Plan Information

Troy Medicare (HMO)

Everything you need to know about your Troy Medicare (HMO) plan.

Coverage and Benefits

Who Can Join?

Troy Medicare (HMO) 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.

Summary of Benefits

One of the best things about Troy Medicare is the lack of confusion in plan selection; we offer only two simple options: our core HMO plan and a Dual Eligible Special Needs Plan (DSNP).

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.