Complete the e-form below and a licensed agent will contact you to complete your application.
To get started, please select the county you live in from the list below, enter your zip code, then click the next button.
Good News! We offer plans in your area. Now Let's check eligibility.
We're sorry! You must currently have Medicare Part A & B to proceed.
Typically, you may enroll in a Medicare Advantage plan only during the annual enrollment period from October 15 through December 7 of each year. There are exceptions that may allow you to enroll in a Medicare Advantage plan outside of this period.
Please read the following statements carefully and check the box if the statement applies to you. By checking any of the following boxes you are certifying that, to the best of your knowledge, you are eligible for an Enrollment Period. If we later determine that this information is incorrect, you may be disenrolled.
New Hanover Health FirstMedicare, a product of FirstCarolinaCare Insurance Company of North Carolina, Inc., is a Medicare Advantage organization with a Medicare contract. Enrollment in New Hanover Health FirstMedicare depends on contract renewal.
Please contact New Hanover Health Advantage if you need information in another language or format (Braille).
To Enroll in New Hanover Health FirstMedicare Health Plans, Please Provide the Following Information:
Please provide the following information:
Thank you. You have chosen to enroll in:
NEW HANOVER HEALTH FIRSTMEDICARE SELECT HMO-POS
NEW HANOVER HEALTH FIRSTMEDICARE PLATINUM HMO-POS
OPTIONAL SUPPLEMENTAL BUY-UP DENTAL SILVER PLAN
OPTIONAL SUPPLEMENTAL BUY-UP DENTAL GOLD PLAN
Now you can:
Please take our your red, white, and blue Medicare card to complete this section.
You must have Medicare Part A and Part B to join a Medicare Advantage plan.
If we determine that you owe a late enrollment penalty (or if you currently have a late enrollment penalty), we need to know how you would prefer to pay it. You can pay by mail or "Electronic Funds Transfer (EFT)" each month. You can also choose to pay your premium by automatic deduction from your Social Security or Railroad Retirement Board (RRB) benefit check each month. If you are assessed a Part D-Income Related Monthly Adjustment Amount, you will be notified by the Social Security Administration. You will be responsible for paying this extra amount in addition to your plan premium. You will either have the amount withheld from your Social Security benefit check or be billed directly by Medicare or RRB. DO NOT pay New Hanover Health Advantage the Part D-IRMAA.
You can pay your monthly plan premium (including any late enrollment penalty that you currently have or may owe) by mail or "Electronic Funds Transfer (EFT)" each month. You can also choose to pay your premium by automatic deduction from your Social Security or Railroad Retirement Board (RRB) benefit check each month.
If you are assessed a Part D-Income Related Monthly Adjustment Amount, you will be notified by the Social Security Administration. You will be responsible for paying this extra amount in addition to your plan premium. You will be responsible for paying this extra amount in addition to your plan premium. You will either have the amount withheld from your Social Security benefit check or be billed directly by Medicare or RRB. DO NOT pay New Hanover Health Advantage the Part D-IRMAA.
People with limited incomes may qualify for Extra Help to pay for his/her prescription drug costs. If eligible, Medicare could pay for 75% or more of your drug costs including monthly prescription drug premiums, annual deductibles, and co-insurance. Additionally, those who qualify will not be subject to the coverage gap or late enrollment penalty. Many people are eligible for these savings and don't even know it. For more information about this Extra Help, contact your local Social Security office, or call Social Security at 1-800-772-1213. TTY users should call 1-800-325-0778. You can also apply for extra help online at www.socialsecurity.gov/prescriptionhelp.
If you qualify for Extra Help with your Medicare prescription drug coverage costs, Medicare will pay all or part of your plan premium. If Medicare pays only a portion of this premium, we will bill you for the amount that Medicare doesn't cover.
If you don't select a payment option, you will get a bill each month.
(The Social Security/RRB deduction may take two or more months to begin after Social Security or RRB approves the deduction. In most cases, if Social Security or RRB accepts your request for automatic deduction, the first deduction from your Social Security or RRB benefit check will include all premiums due from your enrollment effective date up to the point withholding begins. If Social Security or RRB does not approve your request for automatic deduction, we will send you a paper bill for your monthly premiums.)
Some individuals may have other drug coverage, including other private insurance, TRICARE, Federal employee health benefits coverage, VA Benefits, or State pharmaceutical assistance programs.
If 'yes,' please list your other current coverage and your identification (ID) number(s) for this coverage:
If 'yes,' please provide the following information:
If 'yes,' please provide the folowing information:
Please contact New Hanover Health Advantage at XXX_XXX_XXXX, if you need information in another format or language than what is listed above. TTY users should call 711.
Please Read This Important Information
If you currently have health coverage from an employer or union, joining New Hanover Health FirstMedicare could affect your employer or union health benefits. You could lose your employer or union health coverage if you join New Hanover Health FirstMedicare. Read the communications your employer or union sends you. If you have questions, visit their website, or contact the office listed in their communications. If there isn't any information on whom to contact, your benefits administrator or the office that answers questions about your coverage can help.
By completing this enrollment application, I agree to the following:
New Hanover Health FirstMedicare, a product of FirstCarolinaCare Insurance Company of North Carolina, Inc., is a Medicare Advantage organization with a Medicare contract. with the Federal government. I will need to keep my Medicare Parts A and B. I can be in only one Medicare Advantage plan at a time, and I understand that my enrollment in this plan will automatically end my enrollment in another Medicare health plan or prescription drug plan. It is my responsibility to inform you of any prescription drug coverage that I have or may get in the future. I understand that if I don't have Medicare prescription drug coverage, or creditable prescription drug coverage (as good as Medicare's), I may have to pay a late enrollment penalty if I enroll in Medicare prescription drug coverage in the future. Enrollment in this plan is generally for the entire year. Once I enroll, I may leave this plan or make changes only at certain times of the year when an enrollment period is available (Example: October 15 - December 7 of every year), or under certain special circumstances.
New Hanover Health FirstMedicare serves a specific service area. If I move out of the area that New Hanover Health FirstMedicare serves, I need to notify the plan so I can disenroll and find a new plan in my new area. Once I am a member of New Hanover Health FirstMedicare, I have the right to appeal plan decisions about payment or services if I disagree. I will read the Evidence of Coverage document from New Hanover Health FirstMedicare when I get it to know which rules, I must follow to get coverage with this Medicare Advantage plan. I understand that people with Medicare aren't usually covered under Medicare while out of the country except for limited coverage near the U.S. border.
I understand that beginning on the date New Hanover Health FirstMedicare coverage begins, using services in-network can cost less than using services out-of-network, except for emergency or urgently needed services or out-of-area dialysis services. Services authorized by New Hanover Health FirstMedicare and other services contained in my New Hanover Health FirstMedicare Evidence of Coverage document (also known as a member contract or subscriber agreement) will be covered. Without authorization, NEITHER MEDICARE NOR New Hanover Health FirstMedicare WILL PAY FOR THE SERVICES.
I understand that if I am getting assistance from a sales agent, broker, or other individual employed by or contracted with New Hanover Health FirstMedicare he/she may be paid based on my enrollment in New Hanover Health FirstMedicare.
Release of Information: By joining this Medicare health plan, I acknowledge that New Hanover Health FirstMedicare will release my information to Medicare and other plans as is necessary for treatment, payment and health care operations. I also acknowledge that New Hanover Health FirstMedicare will release my information including my prescription drug event data to Medicare, who may release it for research and other purposes which follow all applicable Federal statutes and regulations. The information on this enrollment form is correct to the best of my knowledge. I understand that if I intentionally provide false information on this form, I will be disenrolled from the plan.
We are providing this link for your convenience. You will be accessing information at a website not controlled by New Hanover Health Advantage.
To continue please click proceed below. Otherwise close this window to remain on the New Hanover Health Advantage website.
New Hanover Health Advantage Virtual Information Sessions provide a free way to learn about our 2023 Medicare Advantage & Rx Drug plans.
October 18 through November 29
Call 1(855) 291-9336 or visit here to learn more and register