FirstMedicare Direct  
 
FirstMedicare Direct HMO plans are rated 4 out of 5 Stars for calendar year 2020 by Centers for Medicare and Medicaid Services (CMS).
Click HERE for 2020 Stars information.
Click HERE for 2019 Stars information.

Frequently Asked Questions


How do I contact Member Services?

1 (844) 499-5630
TTY/TDD users should call 711

  • Hours for October 1 – March 31: Seven days a week, 8:00a.m. – 8:00p.m. Eastern
  • Hours for April 1 – September 30: Monday – Friday 8:00a.m. – 8:00p.m. Eastern

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How do I contact the Nurse Advice Line?

Call 1 (844) 323-2247 (toll free).


How do I contact Medicare?

1 (800) 633-4227 (1-800-Medicare)
Medicare TTY/TDD users should call 1 (877) 486-2048

For general information or inquires, go to www.medicare.gov.

To file a complaint, go to www.medicare.gov/medicarecomplaintform/home.aspx.

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How do I contact Social Security Administration?

1 (800) 772-1213

Hours 7 a.m. – 7 p.m., Monday, Tuesday, Wednesday, Thursday, Friday

TTY/TDD users should call 1-800-325-0778

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How do I contact NC SHIIP?

NC SHIIP (Seniors’ Health Insurance Information Program) 
1 (855) 408-1212

Visit www.ncdoi.com/SHIIP/                                                                            

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How can I get Extra Help with my prescription drug plan costs or other Medicare costs?

You may be able to get extra help to pay for your prescription drug premiums and costs as well as get help with other Medicare costs. To see if you qualify for getting extra help, call:

  • • 1 (800) MEDICARE (1 (800) 633-4227).
    TTY/TDD users should call 1 (877) 486-2048, 24 hours a day/7 days a week and see www.medicare.gov 'Programs for People with Limited Income and Resources' in the publication Medicare & You.
     
  • • The Social Security Administration 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
     
  • • Your State Medicaid Office

• Human Arc Premium - www.humanarc.com

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What are my rights and protections?
If you would like to file an appeal with FirstMedicare Direct about a coverage decision please click on one of the links below to review our Appeals & Grievances process or open the appropriate form.

Your Rights and Responsibilities Adobe PDF

Member Rights and Responsibilities if you Disenroll Adobe PDF

What to do if you have a problem or complaint Adobe PDF

    For information on how to obtain an aggregate number of appeals and grievances, please contact customer service at (844) 201-4957.

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What are Star Plan Ratings?
CMS rates Medicare Advantage plans on a scale of one to five stars, with five stars representing the highest quality. The CMS defines the star ratings in the following manner: 

5 Stars   Excellent performance 
4 Stars   Above average performance 
3 Stars   Average performance 
2 Stars   Below average performance 
1 Star     Poor performance 

All Health Maintenance Organizations (HMOs ), Point of Service (POS) plans, local Preferred Provider Organizations (PPOs), regional PPOs, and Private Fee-for-Service (PFFS) plans are eligible for bonus payments, and are rated by CMS unless they are too new or have too few enrollees. FirstMedicare Direct smartHMO has a 4 out of 5 Star rating.

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How do I appoint a representative?
Appointment of a Representative Form Adobe PDF (located on www.cms.hhs.gov)

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How do I find hospice care?
To find hospice care near you please go to www.homeandhospicecare.org for a listing of Hospice Organizations in North Carolina.

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In what counties are FirstMedicare Direct plans available?

In Sandhills NC: Chatham, Hoke, Lee, Montgomery, Moore, Richmond, Scotland

In Central NC: Wake

In Western NC: Buncombe, Henderson, Madison, McDowell, Transylvania and Yancey

In Coastal NC: New Hanover

Note – Not all plans are available in all counties.  Please return to the home page and enter your county of residence to go to the Find a Plan page that lists available plans in that county.

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FirstCarolinaCare Insurance Company’s FirstMedicare Direct plans are HMO and PPO plans with a Medicare contract. Enrollment in a FirstMedicare Direct plan depends on contract renewal.This is a required statement by CMS. FirstCarolinaCare has filed and been approved to offer an HMO and a PPO Medicare Advantage Prescription Drug plan for 2020.

 
Y0094_20042M_Accepted_10/01/2019

Page Last Updated:
Friday, October 02, 2020 10:13:50 AM