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Frequently Asked Questions

If you have a question, be sure to check here first. We may have already answered it for you.

What is Medicare and who is eligible for it?
Medicare is a health insurance program for:

  • People age 65 or older,
  • People under age 65 with certain disabilities, and
  • People of all ages with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a kidney transplant).

What are the different parts of Medicare?
Part A Hospital Insurance - Most people do not pay a premium for Part A because they or a spouse already paid for it through their payroll taxes while working. Medicare Part A (Hospital Insurance) helps cover inpatient care in hospitals, including critical access hospitals, and skilled nursing facilities (not custodial or long-term care). It also helps cover hospice care and some home health care. Beneficiaries must meet certain conditions to get these benefits.

Part B Medical Insurance - Most people pay a monthly premium for Part B. Medicare Part B (Medical Insurance) helps cover doctors' services and outpatient care. It also covers some other medical services that Part A does not cover, such as some of the services of physical and occupational therapists, and some home health care. Part B helps pay for these covered services and supplies when they are medically necessary.

Prescription Drug Coverage - Most people will pay a monthly premium for this coverage. Starting January 1, 2006, new Medicare prescription drug coverage became available to everyone with Medicare. Everyone with Medicare can get this coverage that may help lower prescription drug costs and help protect against higher costs in the future. Medicare Prescription Drug Coverage is insurance. Private companies provide the coverage. Beneficiaries choose the drug plan and pay a monthly premium. Like other insurance, if a beneficiary decides not to enroll in a drug plan when they are first eligible, they may pay a penalty if they choose to join later.

Who is eligible to enroll in a GHI PPO Medicare Advantage Plan?
You are eligible to enroll in a GHI Medicare PPO Plan if:

  • You qualify for Medicare Part A
  • You are enrolled in and continue to pay Medicare Part B; and
  • You reside in GHI's service area. GHI's service area includes: New York, Bronx, Kings, Queens, Richmond, Nassau, Suffolk, Orange, Ulster, Dutchess, Rockland, and Westchester..

Note: You will not qualify if you have End-Stage Renal Disease (permanent kidney disease requiring dialysis or a kidney transplant), except under certain limited circumstances.

What Medicare Advantage Plans does GHI offer?
GHI's Medicare PPO Plans are Preferred Provider Organization (PPO) that give you the flexibility to seek coverage from the broad network of GHI providers, or from a Medicare-approved provider outside of the GHI network.

GHI Medicare SNP Plan
The GHI PPO Any Dual Plan is for people with both Medicare and some level of Medicaid. As with our other Medicare plans, PPO Any Dual includes all the benefits of Original Medicare and more, as well as Part D prescription drug coverage. Depending on your level of Medicaid eligibility, you may use your Medicaid card to obtain Medicaid covered services or additional services covered by Medicaid. This plan is only available in New York City, Westchester and Rockland counties.

The GHI PPO Value plan optimizes your Medicare benefits, along with full Medicaid medical assistance from the State. If you qualify you will have access to Medicare and Medicaid services as well as community services, where applicable. PPO Value includes all of the benefits of Original Medicare, plus Part D Prescription Drug coverage, and also provides the majority of your Medicaid services through GHI network providers. Members must use their Medicaid card only for Medicaid Services which are not covered by GHI. PPO Value is available in New York City, and Westchester, and Rockland counties.

PDP Plan
If you want a GHI PDP plan that only covers prescription drugs, you might be interested in joining the GHI Medicare Prescription Drug Plan. When you enroll in the GHI Medicare PDP plan, you will be entitled to receive GHI’s prescription drug benefits and discounts without receiving health care coverage through GHI.

Why should I choose GHI?
When you look at all of the options, there are lots of good reasons to choose one of the GHI Medicare PPO Plans. All of our benefit plans are designed to offer you extra care to help you stay healthy and enjoy a better quality of life.

There's another important reason to choose GHI. We work hard to provide you with a positive customer experience whenever you call. There's nothing more frustrating than being unable to get the help you need, when you need it. So when you have questions, we will respond in simple, clear, easy-to-understand language.

How do I enroll?
Call us toll-free at 1-800-611-8454 Monday - Friday 8:00 am - 6:00 pm. Extended hours 11/15 - 3/1, 8:00 am - 8:00 pm, seven days a week (TTY/TDD users, 1-888-447-4833, Monday – Friday 8:30 am – 5:00 pm) to:

  • Schedule an a personal consultation with a GHI Representative who will answer your questions and assist you with completing the enrollment application.
  • Reserve a seat for you at one of our informational seminars in your area, where you can find out more about our GHI Medicare Plans and a GHI Representative will be present and can assist you with completing your enrollment application. For accommodations of persons with special needs, contact us at the toll-free number listed above.
  • Request an enrollment kit.

When can I enroll?
You can only enroll in a GHI Medicare Plan during specific times of the year. For more information on enrollment periods, please call us toll-free at 1-800-611-8454 , 8:00 am - 6:00 pm, Monday - Friday. Extended hours 11/15 - 3/1, 8:00 am - 8:00 pm, seven days a week (TTY/TDD users, 1-888-447-4833, Monday – Friday 8:30 am – 5:00 pm). Here are some important enrollment dates:

Initial Coverage Election Period
You can enroll when you first become eligible for Medicare (three months before the month you turn age 65 until three months after the month you turn age 65). If you get Medicare due to a disability, you can join from three months before to three months after your 25th month of cash disability payments.

November 15 - December 31 (Annual Election Period)
If you are eligible for Medicare, you can enroll in or switch plans during the Annual Election Period. For example, you can switch from Original Medicare to a Medicare Advantage Plan (like a GHI PPO Medicare Plan). Your coverage will be effective on January 1.

January 1 - March 31 (Open Enrollment Period)
If you are already enrolled in a Medicare plan, you can switch plans once during the Open Enrollment Period, but you cannot add or drop Medicare prescription drug coverage. For example, you can switch from Original Medicare and a Prescription Drug Plan (PDP) to a Medicare Advantage Plan with prescription drug coverage (MA-PD).

After March 31
You generally cannot make any changes to your Medicare coverage for the remainder of the current year unless you meet special exceptions, such as if you move, if you have Medicaid coverage, or if you get extra help in paying for your drugs.

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