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2021 Annual Notice of Change & Evidence of Coverage

The Evidence of Coverage booklet tells you how to get your Medicare medical care and prescription drugs (if applicable) through a Medicare Advantage plan.

The Evidence of Coverage booklet explains:

  • Member rights and responsibilities
  • What is covered
  • What you will pay as a member of the plan

The benefits listed in the Evidence of Coverage are effective January 1st of the current year. Benefits, formulary, pharmacy network, premium and/or copayments/co-insurance may change on January 1, 2021.

Medicare Advantage HMO Plans

Medicare Advantage PPO Plans

Optional Supplemental Dental Benefit

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Content last updated October 1, 2020