This document is available in alternative formats. You must continue to pay your Medicare Part B premium if not otherwise paid for under Medicaid or by another third party. You must have Medicare Parts A and B, and must reside in Alameda County, the service area of the plan. You must have Medi-Cal in addition to Medicare to enroll in the plan. You must receive all routine care from plan providers who have an arrangement with Alliance CompleteCare. Your primary care provider will provide or arrange for most of your covered services. Routine care or services you get from providers who are not part of Alliance CompleteCare will not be covered, with few exceptions such as emergencies, urgent care, and out-of-area dialysis.

You may be able to get extra help to pay for your prescription drug premiums and costs. To see if you qualify for getting extra help, call: 1-800-MEDICARE (1-800-633-4227), 24 hours a day/7 days a week; TTY/TDD users should call 1-877-486-2048; Social Security at 1-800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday; TTY/TDD users should call-1-800-325-0778, or visit www.socialsecurity.gov; or the Alameda County Medi-Cal Office at 1-800-698-1118; TTY/TDD users should dial 711.

If you have Medicare and Medi-Cal, you can join Alliance CompleteCare at any time. Medicare beneficiaries may enroll in Alliance CompleteCare through the Centers for Medicare & Medicaid Services Online Enrollment Center, located at www.medicare.gov. Beneficiaries may join, switch, or drop a Medicare Advantage plan only during specified times of the year, except in certain situations. Some of these situations include the following:

• If you move out of your plan’s service area
• If you have both Medicare and Medicaid
• If you qualify for “extra help”
• If you live in an institution

For more information, call the Care Advisor Unit at 1-877-585-PLAN (7526) or TTY 1-888-747-1574, 7 days a week, 8 a.m. - 8 p.m. Alliance CompleteCare’s Prescription Drug Benefit is only available to enrollees of Alliance CompleteCare. By enrolling in our plan, you will be disenrolled from your former plan—and you must obtain all your medical and prescription drug coverage through the Alliance.

The pharmacy network includes retail, mail order, long-term care, home infusion, and specialty pharmacy services. For information about mail order, names and addresses of network pharmacies or for more information about benefits, call Alliance CompleteCare toll-free at 1-877-585-PLAN (7526); TTY users can call 1- 888-747-1574, 7 days a week, from 8 a.m. to 8 p.m. You must use a network pharmacy to receive plan benefits. You may be able to have access to covered drugs dispensed at out-of-network pharmacies if you are unable to obtain a covered drug at a network pharmacy in a timely manner within our service area and you are not accessing out-of-network pharmacy services on a routine basis.

The plan’s contract with CMS is renewed annually. Availability of coverage beyond the end of the current contract year is not guaranteed. Alliance CompleteCare is offered by Alliance for Health, a health plan with a Medicare contract.