• Plans Resource

  • Plan Assistance

    Research or Buy a Plan

    Phone: 888.543.9096 (TTY 711)
    Monday to Sunday, 8:00 am - 8:00 pm ET

    Visit the online member application

    Customer Service

    Have a question about how your plan works? Don’t see what you’re looking for? We’re here to help!

    Call Us (Monday to Sunday, 8:00 am - 8:00 pm ET):

    • Phone: 877.234.4499
    • TTY: 711
    • Fax: 718.794.7804

    In Person:
    Visit a Community Service Centers (CSC)

    Headquarters
    Metro Center Atrium
    1776 Eastchester Road
    Bronx, NY 10461

    Online Access

    Set up and manage your personal account options, including:

    • View/pay your monthly bill
    • Select/change your PCP
    • Print a temporary ID card
    • Review your benefits

    Log in or create an account

    Claims

    Phone: 877.234.4499
    Monday to Sunday, 8:00 am - 8:00 pm ET

    For Part C (medical) requests
    Affinity Health Plan, Customer Service Department (Medicare)
    Metro Center Atrium
    1776 Eastchester Road
    Bronx, NY 10461

    For Part D (prescription drug) requests
    Caremark Inc., Medicare Part D Claims
    P.O. Box 52066
    Phoenix, AZ 85072-2066

    Pharmacy Claims Form: English | Spanish
    Pharmacy Directory: English

  • Benefits Assistance

    Important Numbers and Contacts

    Medicare
    How can you get help and information directly from the Federal Medicare program, visit www.medicare.gov. This is the official government website for Medicare. It gives you up-to-date information about Medicare and current Medicare issues. It also has information about hospitals, nursing homes, physicians, home health agencies, and dialysis facilities. It includes booklets you can print directly from your computer. You can also find Medicare contacts in your state. Call 800.MEDICARE, or 800.633.4227 (TTY 711). Calls to this number are free 24 hours a day, 7 days a week.

    Affinity Ethics Line
    Affinity Health Plan is committed to providing our Members with access to high quality medical care while complying with ethical and professional business practices and all federal, state, and local laws and regulations. Call the Ethics line to make a report 866.528.1505

    Medicare Part D Services
    CVS Caremark is Affinity's pharmacy benefits manager for our Medicare Part D. Members in these programs can get prescription drugs not only at CVS pharmacies but all the other chain and independent pharmacies that participate in our network. To find a pharmacy near you use our pharmacy search. For questions about your Part D drug coverage call 866.362.4002 (TTY 711).

    Healthways SilverSneakers® Fitness Program
    SilverSneakers® is a fitness benefit for seniors that comes free with qualifying Medicare health plans. It provides unlimited access to 14,000+ fitness locations nationwide. From weights and machines to group classes led by trained instructors, SilverSneakers has something for everyone at all levels of ability. Get active, have fun and make new friends with SilverSneakers. For more information or to find a location, visit silversneakers.com or call 1.888.423.4632 (TTY 711), Monday through Friday, 8 a.m. to 8 p.m.

    Superior Vision
    A national vision benefits manager that provides routine vision care for our members. Visit our website to find a vision provider near you, or call 800.879.6901.

    Dental Services
    DentaQuest provides dental services to our members through their network of contracted dental providers. To find a dental provider near you call 866.731.8004.

    Chiropractic and Acupuncture Services
    EviCore provides managed chiropractic and acupuncture services to our Medicare members through its local provider network. To find a provider near you or for more information call 800.638.4557.

    Star Ratings

    Each year, the Centers for Medicare and Medicaid Services rates plans based on a 5-star system, in areas including customer service, drug pricing and patient safety. Star Ratings may change from one year to the next. See a summary of quality and performance for Affinity’s Medicare plans based on 19 different topics here: English | Spanish | Chinese

    Low Income Subsidy (LIS) Table

    For Affinity Medicare Ultimate (HMO/SNP) and Affinity Medicare Solutions (HMO/SNP) members who get extra help from Medicare to pay for their prescription drug costs, these tables show what the monthly plan premium will be within the respective year of service.

    Appointment of a Representative

    This form is used when someone who is not the member would like information or assistance on your behalf. Your representative can be a family member, friend, advocate, attorney, doctor or anyone else you would like to act on your behalf: English | Spanish

    Multi Language Interpreter Services

    Find information on free interpreter services to answer any questions you may have about our health or drug plans.

    Leaving Our Plan

    While we value your membership with Affinity, there are certain circumstances when your Affinity Medicare coverage could be terminated or you might be disenrolled. Moving out of the service area, losing your Medicaid eligibility, and wanting to change your plan are just a few of the reasons. Learn how your benefits would be affected below.

    Potential for Coverage Termination
    Your Affinity Medicare coverage could end under certain circumstances. These include but are not limited to:

    • Permanently moving out of the service area.
    • Fraud or material misrepresentation in enrollment or in the use of services or facilities.
    • Losing your Medicaid eligibility.

    Potential for Affinity Medicare Programs Contract Termination
    Affinity Health Plan has a contract with the Centers for Medicare & Medicaid Services (CMS), the government agency that runs Medicare. This contract may be renewed each year. However, our plan or CMS can decide to end the contract at any time. You will generally be notified in writing 90 days in advance if this situation occurs. However, your advance notice may be as little as 30 days, or even fewer days if CMS must end our contract in the middle of the year.

    If Affinity Health Plan’s Medicare contract with CMS ends:

    • The benefits and rules described in your Evidence of Coverage will continue until your membership ends.
    • You will qualify for a special enrollment period so you can enroll in another Medicare plan to continue your coverage.

    Please see your Evidence of Coverage for a complete list of termination of coverage and disenrollment provisions.

    Rights and Responsibilities Upon Disenrollment
    "Disenrollment" from Affinity means ending your membership with us. Disenrollment can be voluntary (your choice) or, in limited circumstances, involuntary (not your choice):

    • You might leave one of our plans because you decide that you want to leave.
    • Some situations require you to leave. For example, if you move out of our service area for more than six consecutive months.

    Please refer to your Evidence of Coverage for more information, to learn about choices you have after you leave, and to review the rules that may apply.

    To disenroll, you must send Affinity a written notice stating that you would like to disenroll from our plan, or you can call 800.MEDICARE (TTY 711), 24 hours a day, 7 days a week.

    Your coverage under Original Medicare resumes on the effective date of your disenrollment from Affinity.

  • Treatment Cost Calculator

    This Treatment Cost Calculator will help you better understand the potential costs of obtaining health care services when you need treatment. English | Español

  • Programs

    Care Management Programs

    Medical Programs
    These are programs focused on health conditions such as high blood pressure, cholesterol, asthma, and special diets. They are designed to enrich the health and lifestyles of our members: English | Spanish

    Medication Therapy Management Program (MTM Program)

    The Affinity Health Plan Medication Therapy Management (MTM) program helps you get the greatest health benefit from your medications by:

    • Preventing or reducing drug-related risks
    • Increasing your awareness
    • Supporting good habits

    Medication Therapy Management Program Qualifications
    We will automatically enroll you in the Affinity Health Plan Medication Therapy Management Program at no cost to you if all three (3) conditions apply:

    • You take eight or more Medicare Part D covered maintenance drugs
    • You have three or more of these long term health conditions
      • Asthma
      • COPD
      • Diabetes
      • Depression
      • Osteoporosis
      • Chronic Heart Failure
      • HIV
      • Cardiovascular Disorders such as High Blood Pressure, High Cholesterol, or Coronary Artery Disease
       
    • You reach,
      • in 2019, $4,044 in yearly prescription drug costs paid by you and the plan
      • in 2018, $3,967 in yearly prescription drug costs paid by you and the plan
       

    Your participation is voluntary, and does not affect your coverage. This program is free of charge and is open only to those who are invited to participate. The MTM program is not a benefit for all members.

    Forms

  • Medication Therapy Management Program FAQs

    What services are included in the Medication Therapy Management Program (MTM Program)?

    The MTM Program provides you with a Comprehensive Medication Review (CMR), and a Targeted Medication Review (TMR).

    Comprehensive Medication Review (CMR)
    A CMR is a one-on-one discussion with a pharmacist, to answer questions and address concerns you have about the medications you take, including

    • Prescription drugs
    • Over-the-counter (OTC) medicines
    • Herbal therapies
    • Dietary supplements and vitamins

    The pharmacist will offer ways to manage your conditions with the drugs you take. If more information is needed, the pharmacist may contact your prescribing doctor. A CMR review takes about 30 minutes and usually offered once each year—if you qualify. At the end of your discussion, the pharmacist will give you a Personal Medication List with the medications you discussed during your CMR.

    You will also receive a Medication Action Plan. Your plan may include suggestions from the pharmacist for you and your doctor to discuss during your next doctor visit.

    Targeted Medication Review (TMR)
    With a TMG, we mail, fax or call your doctor with suggestions about prescription drugs that may be safer, or work better than your current drugs. As always, your prescribing doctor will decide whether to consider our suggestions. Your prescription drugs will not change unless you and your doctor decide to change them. We may also contact you, by mail or phone, with suggestions about your medications.

    How will I know if I qualify for the Medication Therapy Management Program (MTM Program)?

    If you qualify, we will mail you a letter letting you know that you qualify for the MTM program. Afterward, you may receive a call from a partner pharmacy, inviting you to schedule a one-on-one medication review at a convenient time.

    Will the Medication Therapy Management Program (MTM Program) pharmacist be calling from my regular pharmacy?

    Yes, the MTM program pharmacist may be calling from your regular pharmacy if your regular pharmacy chooses to participate in the MTM Program as a service provider. You will be given the option to choose an in-person review or a phone review.

    If your regular pharmacy does not participate in the program, you may be contacted by a Call Center pharmacist to provide your MTM review, and ensure that you have access to the service if you want to participate. Call center reviews are conducted by phone.

    Will the Medication Therapy Management Program (MTM Program) pharmacist be calling from my regular pharmacy?

    Yes, the MTM program pharmacist may be calling from your regular pharmacy if your regular pharmacy chooses to participate in the MTM Program as a service provider. You will be given the option to choose an in-person review or a phone review.

    If your regular pharmacy does not participate in the program, you may be contacted by a Call Center pharmacist to provide your MTM review, and ensure that you have access to the service if you want to participate. Call center reviews are conducted by phone.

    Why is a review with a pharmacist important?

    Different doctors may write prescriptions for you without knowing all the prescription drugs and/or OTC medications you take. For that reason, a pharmacist will:

    • Discuss how your prescription drugs and OTC medications may affect each other.
    • Identify any prescription drugs and OTC medications that may cause side effects, and offer suggestions to help.
    • Help you get the most benefit from all of your prescription drugs and OTC medications.
    • Review opportunities to help you reduce your prescription drug costs.
    How do I benefit from talking with a pharmacist?
    • Discussing your medications can result in real peace of mind knowing that you are taking your prescription drugs and OTC medications safely.
    • The pharmacy can look for ways to help you save money on your out-of-pocket prescription drug costs.
    • You benefit by having a Personal Medication List and a Medication Action Plan to keep and share with your doctors and health care providers
    How can I get more information about the MTM program?

    Please contact us if you would like additional information about our MTM Program, or if you do not want to participate after being enrolled in the program. Our toll free number is 866.362.4002, 24 hours a day, 7 days a week. TTY users call 711

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  • Affinity Health Plan is an HMO and HMO-SNP Plan with a Medicare contract and a contract with the New York State Medicaid Managed Care Program. Enrollment in Affinity Health Plan depends on contract renewal. This information is not a complete description of benefits. Contact the plan for more information. Limitations, copayments, and restrictions may apply. Benefits, premiums and/or copayments/co-insurance and restrictions may change on January 1 of each year. You must continue to pay your Medicare Part B premium. Premiums, Part D co-pays, coinsurance, and deductibles may vary based on the level of Extra Help you receive. Please contact the plan for further details. This plan is available to anyone who has both Medical Assistance from the State and Medicare. Affinity Health Plan complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. ATENCIÓN: Si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 877.234.4499 (TTY: 711). 注意:如果您使用繁體中文,您可以免費獲得語言援助服務。請致電 877.234.4499 (TTY: 711) 。