Bright Advantage Embrace Care Plan (HMO C SNP)

Overview

The Bright Advantage Embrace Care Plan is a MedicareAdvantage (Part C) Special Needs Plan (SNP) designed for seniors who qualify for the Dual Eligible statusthose who receive both Medicare and Medicaid. As an HMOtype SNP, the plan requires members to use a defined network of doctors, hospitals, and other healthcare providers. The Embrace Care Plan emphasizes coordinated, patientcentered care, helping members navigate complex health needs while keeping outofpocket costs low.

Eligibility

To join Bright Advantage Embrace, you must meet all of the following criteria:

• Be enrolled in both Medicare Part A and Part B.
• Qualify for full Medicaid benefits (or meet statespecific criteria for dual eligibility).
• Live in the service area where the plan is offered (check the plans geographic map).
• Not be enrolled in another Medicare Advantage or Medicare Cost Plan.

Eligibility is verified during the enrollment process using your Medicare and Medicaid identification numbers.

Key Benefits

Bright Advantage Embrace combines Medicare coverage with extra services that address the unique challenges faced by dualeligible members.

• Zero or low monthly premiums most members pay $0$10 per month.
• Zero or reduced copayments for primary care, specialist visits, emergency services, and hospital stays.
• Prescription drug coverage (Part D) with low or no costsharing for generic and brandname medications.
• Comprehensive care coordination through a dedicated care manager who helps schedule appointments, arrange transportation, and monitor health status.
• Wellness and preventive services including annual wellness visits, vaccinations, and healthrisk assessments.
• Dental, vision, and hearing benefits not normally covered by Original Medicare.
• Telehealth and virtual visits to improve access for members with mobility or transportation barriers.

Coverage Details

Medical Services

All services covered under Medicare Part A (inpatient hospital, skilled nursing facility, hospice) and Part B (outpatient, preventive care) are included. The HMO structure adds a layer of network management, so you must receive care from a planapproved provider except in true emergencies.

Prescription Drugs

Formulary tiers are structured to keep costs low:

Additional Services

• Dental cleanings twice a year, two sets of dentures, and limited restorative work.
• Vision exam annually, allowance for glasses or contacts.
• Hearing exam and up to $150 toward hearing aids every two years.
• Fitness memberships or inhome exercise programs for eligible members.

How to Enroll

Enrollment is open during the Medicare Annual Election Period (AEP) from October1 to December15, and during Special Enrollment Periods (SEPs) triggered by life events such as moving to a new service area, loss of other coverage, or qualifying for Medicaid.

1. Visit the Bright Advantage website or call the enrollment hotline.
2. Provide your Medicare Beneficiary Identifier (MBI) and Medicaid ID.
3. Complete the enrollment questionnaire confirming eligibility.
4. Choose a primary care provider (PCP) from the network.
5. Receive your member ID card in the mail (usually within 10 business days).

Assistance is available in multiple languages, and a licensed enrollment counselor can walk you through each step.

Provider Network

The plan contracts with a broad network of hospitals, physicians, specialists, and community health centers. Network maps are available online and are updated quarterly. If you need care outside the network, you must obtain prior authorization or may incur higher outofpocket costs.

Key network features include:

• Integrated electronic health records to share information among providers.
• Onsite care coordinators at participating hospitals.
• Home health agencies offering skilled nursing, physical therapy, and medication management.

Cost & Payments

Because the plan is designed for dualeligible members, most costsharing is eliminated or dramatically reduced. Typical cost structure:

• Monthly Premium: $0$10 (depending on state subsidies).
• Deductible: $0 for medical services; $0$5 for prescription drugs.
• Copay/Coinsurance: $0$5 for primary care, $0$15 for specialist visits, $0$20 for emergency department (nonadmitted).
• OutofPocket Maximum: $1,500 for combined medical and pharmacy costs (most members never reach this limit).

All payments are coordinated with Medicaid, so eligible members often owe nothing after the plans costsharing is applied.

Frequently Asked Questions

1. Can I keep my current doctors?

If your doctors are part of the Bright Advantage network, you can keep them as long as they accept the plans terms. If they are outofnetwork, youll need to select a new PCP or obtain a referral for outofnetwork care.

2. What happens if I travel out of state?

Emergency care is covered nationwide. For nonemergency services while traveling, you may use the plans national provider directory or arrange a temporary outofnetwork authorization, which may involve higher costsharing.

3. How are my Medicare and Medicaid benefits coordinated?

The plan acts as the primary payer for all Medicare services. Medicaid pays for costsharing that Medicare does not cover, such as premiums, deductibles, and certain longterm services.

4. Are there any penalties for switching plans?

Switching during the AEP is free of penalty. However, leaving the plan outside a qualified SEP may result in a coverage gap until the next enrollment period.

5. How does care coordination work?

Each member is assigned a care manager who reviews health data, contacts you regularly, and helps schedule appointments, arrange transportation, and monitor medication adherence.

Contact Information

Customer Service: 18005550123 (MonFri 8am6pm EST)

Enrollment Hotline: 18005550199 (available 24hours during AEP)

Email: info@brightadvantage.com

Visit the official plan webpage for detailed provider lists, downloadable benefit booklets, and enrollment forms.