1-855-962-7325 (TTY: 711)
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Member FAQs

Questions? We are here to help!


Whether you’re new to Medicare or new to Peak Advantage, it’s natural that questions pop up from time to time. We’ve put together common questions to help provide the answers you may be looking for. If you’re looking for answers about your specific Peak Advantage Medicare Advantage plan benefits and coverage, we encourage you to log into our member portal and access your MyPeak account.

Why register for a members-only MyPeak account?

Your MyPeak account gives you 24/7 online access to personalized information and lets you manage the details of your plan. Here are a few of the things you can do through your MyPeak account:

  • View plan benefits and claim statements
  • Find network doctors and pharmacies
  • Learn about covered preventive care
  • Download plan-related documents

Login or sign up to our Member Portal

Is there anything I can do before I receive my member ID card?

While you’re waiting for your member ID card to arrive by mail, there are a few things you can do. For
example, you can explore the network to find providers and pharmacies, find out how to sign in to our
member portal to create your MyPeak account, and schedule your annual wellness visit.

Learn more about what you can do before your member ID card arrives

What if I’m at the doctor and forgot my member ID card?

It’s not a problem. You can sign in to your MyPeak account on your tablet or smartphone and view your
member ID card online.

How do I replace my member ID card?

If you lose your member ID card, please contact us. If your card is damaged, or if you find a mistake on
your member ID card, call the number on your card to request a new card.

Can I switch plans outside of Medicare’s Annual Election Period?

Typically, you can only enroll in a different Medicare Advantage plan or switch between Original Medicare and Medicare Advantage during specific times each year — such as Medicare’s Annual Election Period each fall. Coverage begins on January 1 of the following year.

The Medicare Advantage Open Enrollment Period runs from January 1 through March 31 each year. During this period, you can switch from your Medicare Advantage plan to another Medicare Advantage plan, or to Original Medicare with or without a standalone Part D prescription drug plan. Changes made during this period take effect the first of the month following the month you enroll.

Under certain circumstances, you may be eligible for a Special Enrollment Period. These allow you to change your health and/or drug coverage outside normal enrollment periods. For example, if your Medicare Advantage plan would leave your area or you would move out of your plan’s service area, you would be eligible for a Special Enrollment Period to switch to another Medicare Advantage plan or to Original Medicare.

Do I need to keep my red, white, and blue Medicare card?

Yes. You’ll need it if you ever decide to return to Original Medicare. But you can tuck it away in a safe
place or file because as a Peak Advantage plan member, your member ID card is your proof of insurance. It’s the only card you’ll need to show when you receive services.

How do I know what services are covered by my plan?

Your Peak Advantage Medicare Advantage plans covers everything Original Medicare does and more,
but checking your benefits ahead of time may help you avoid surprise costs. It’s good to review what’s
covered (or not covered) and what costs to expect before your appointment.

Sign in to your MyPeak account

View your plan’s Summary of Benefits

Do I need to get referrals to see specialists?

No. You don’t need “permission” from your primary care doctor if you need to see a specialist as a Peak
Advantage Vista or Summit PPO plan member.

How can I check that my doctors and pharmacy are in the network?

We’ve set up easy-to-use online tools to help you. The Peak Health Medicare Provider Directory is a fast
and easy way for you to browse or search for the care you need. You will find practice information,
including office location, hours of operation, parking availability, and nearby public transit information.

You may also browse or download our Pharmacy Directory.

Do I have to pay more if I go outside the network?

PPO plans (including Peak Advantage) include out-of-network benefits that help pay for care you may
receive from providers who don’t take your health plan. However, your share of costs may be higher
except in emergency situations.

What is prior authorization and how do I know if I need it?

Prior authorization means getting approval from Peak before you can get access to certain medications
or services. With prior authorization, your health plan agrees to help pay for the service (this is subject
to any cost-sharing or other limitations) — and it’s important to know that ahead of time.

To see if prior authorization is needed for a medication or service, you can:

  • Call the phone number on your member ID card;
  • Review your plan’s Evidence of Coverage (EOC); or
  • Sign in to your MyPeak account and review your benefits
How do I know what my prescription medication will cost?

All covered medications are assigned to a “Tier” which determines the cost. For example, Tier 1
medications are commonly prescribed generics with a $0 copay. Use our 2024 Formulary (List of
Covered Drugs) to find the Tier for any current or future medications, then check your plan’s Summary of Benefits to find your copay.

When your doctor prescribes medication, check that it is on the formulary and which Tier it is on. You can
ask about a lower-cost alternative if the drug your doctor chooses is too expensive or is not covered. At
times, a similar drug may work just as well, for example, a generic version of the drug.

Will my plan benefits and costs change every year?

Medicare Advantage plan monthly premiums, benefits, cost sharing, and out-of-pocket limits may
change from one year to the next. Each fall, you will be notified of any changes in plan coverage, service
area, or costs for the upcoming year in an Annual Notice of Change (ANOC) document.

Who do I call if I have questions about my plan?

Call our dedicated Member Support Team at 1-855-962-7325 (TTY: 711). Friendly, knowledgeable
representatives are available to assist you from 8 a.m. to 8 p.m., Monday through Friday. This number is
on the back of your member ID card so you’ll always have it handy.