Helpful Resources and Important Documents

2026 Nebraska

• MyAdvocate Medicare Advantage GOLD (HMO-POS)
• MyAdvocate Medicare Advantage SILVER (HMO-POS)

2026 Nebraska

• MyAdvocate Medicare Advantage GOLD (HMO-POS)
• MyAdvocate Medicare Advantage SILVER (HMO-POS)

2026 Nebraska

• MyAdvocate Medicare Advantage GOLD (HMO-POS)
• MyAdvocate Medicare Advantage SILVER (HMO-POS)

• Download our Member Handbook for ChoicePlus and ChoiceElite Members (Coming soon)

Prescription Drug Formulary

• 2026 GOLD and SILVER Formulary

Prior Authorization and Step Therapy Criteria

• 2026 Drug Prior Authorization Criteria (Coming January 2026)
• 2026 Step Therapy Criteria (Coming January 2026)

Prescription Drug Coverage

• Pharmacy Resource Website
• Part B. List of Covered Drugs Requiring a Prior Authorization
• Prescription Drug Prior Authorization Request or Formulary Exception Form
• Prescription Drug Transition Policy
• Medicare Prescription Coverage Educational Guide

• Waiver of Liability

Dental Benefits

Nebraska

• NE ChoiceElite Summary (Coming soon)
• NE Choice Plus Summary (Coming soon)

Vision Benefits

Nebraska

• NE ChoiceElite Summary (Coming soon)
• NE Choice Plus Summary (Coming soon)

Find a doctor:

Easily search for in-network doctors, clinics and hospital locations near you with our online directory (coming soon) or download a printable version below. 

• Facility Directory (Coming soon)
• Primary Care and Specialty Directory (Coming soon)

Find a Pharmacy:

We’ve partnered with major and local pharmacies so you never have to travel far. Search our easy-to-use online directory to find a pharmacy near you, or download the printable version below.

• Pharmacy Directory

• 2026 Enrollment Application

You can keep the health plan you have and enroll in Medicare when you retire.

• If you keep medical coverage through your job and wait to get Part B, you’ll have eight months from when you retire to add Part B without a penalty. When you’re ready to add Part B coverage, contact your local Social Security office.
• If you keep getting drug coverage through your job, you won’t pay a penalty if you add Part D later, as long as the coverage you have is considered creditable.

It’s important to talk to your employer or local insurance agent before choosing to stay on your group plan or enroll in Medicare.

MyAdvocate Medicare Advantage plan options are available in select counties within Nebraska. Your eligibility to enroll in these plans depends on the service area and county where you live.

See if your county is eligible.

Learn more about your plan coverage:

• Find a doctor or pharmacy
• Learn when prior authorization is required for medications
• Learn about drug coverage
• Learn about reimbursement for gym and fitness fees with Optum One Pass
• Learn about our plan ratings by clicking the "What are the ratings for these plans?" below
• Find a complete summary of your benefits in the Resources & Forms section by scrolling to the top of this page

To view a complete summary of your plan’s pharmacy benefits, see your Summary of Benefits document.

Do you qualify for a Low-Income Subsidy (LIS)?
You may be able to get extra help paying for your prescription drug premiums and costs. For more info and to see if you qualify, contact either:

• Medicare at (800) MEDICARE or (800) 633-4227, TTY (877) 486-2048. Help is available 24/7.
• Or the Social Security Administration at (800) 772-1213, TTY (800) 325-0778. Their hours are Monday through Friday from 7 a.m. to 7 p.m.

Star Ratings
CMS publishes the Medicare Advantage and prescription drug plan (Medicare Part D) star ratings each year to help Medicare beneficiaries evaluate the Medicare Advantage plan options available to them.

The rating system helps consumers compare the quality of the plans, empowering them with meaningful information about benefits and costs so that they can make the best decisions regarding their health and well-being.

Star rating overview

• 5 stars: Excellent
• 4 stars: Above Average
• 3 stars: Average
• 2 stars: Below Average
• 1 star: Poor

What are CMS star ratings based on?
Star ratings are based on up to 40 quality and performance measures.

Among the areas considered are:

• Assessing whether members stayed healthy by receiving immunizations or undergoing health screenings, and if their physical health improved after two years
• How often providers recommended tests or treatments to members with chronic conditions, such as rheumatoid arthritis or diabetes
• Member experience and overall satisfaction
• Member complaints, changes in the plan’s performance and whether members chose to leave the plan
• The quality and effectiveness of the health plan’s customer service
• Whether the plan provided accurate drug pricing information and whether drugs were prescribed to members safely

2026 MyAdvocate Star Ratings (Coming soon)

To change your plan:
You can enroll in a plan or switch to a new one during the Annual Enrollment Period (AEP). The Centers for Medicare & Medicaid Services (CMS) chooses this annual time period each year. This period is the only time of year when you can make changes to your plan unless you qualify for a Special Enrollment Period (SEP).

For 2026, the AEP is from Oct. 15 through Dec. 7, 2025. If you enroll during this time, your coverage begins on Jan. 1, 2026.

Contact us if you have any questions.

What are my rights and responsibilities upon disenrollment?
This information explains your rights and responsibilities if you choose to disenroll from your Medicare Advantage plan. You will not be disenrolled from your plan until your disenrollment is processed and approved by the Centers for Medicare and Medicaid Services.

You will continue to obtain your health care from a Medicare Advantage plan until your disenrollment date. Neither your Health Plan nor Medicare will pay for any medical services provided by a physician or hospital, with the exception of urgently needed care, care for a medical emergency, out-of-area renal (kidney) dialysis services, or care that has been approved by us, until your proposed disenrollment date is confirmed.

For a detailed description, please refer to your Evidence of Coverage.

Your rights and responsibilities as a member of our plan upon your disenrollment
You have the right to be treated with dignity, respect and fairness at all times. MyAdvocate Medicare Advantage must obey laws that protect you from discrimination or unfair treatment. These laws do not allow us to discriminate against you (treat you unfairly) because of your race or color, age, religion, national origin, any mental or physical disability and other protections. If you need help with communication, such as help from a language interpreter, please call customer service.

You have the right to the privacy of your medical records and personal health information. There are federal and state laws that protect the privacy of your medical records and personal health information. We protect your personal health information under these laws. Any personal information that you give us when you enroll in a Medicare Advantage plan is protected. We will make sure that unauthorized people do not see or change your records. Generally, we must get written permission from you (or from someone you have given legal power to make decisions for you) before we can give your health information to anyone who is not providing your care or paying for your care. There are exceptions allowed or required by law, such as release of health information to government agencies that are checking on quality of care.

The laws that protect your privacy give you rights related to getting information and controlling how your health information is used. We are required to provide you with a notice that tells about these rights and explains how we protect the privacy of your health information. For example, you have the right to look at your medical records, and to get a copy of the records. You also have the right to ask network providers to make additions or corrections to your medical records (if you ask network providers to do this, they will review your request and determine whether the changes are appropriate). You have the right to know how your health information has been given out and used for non-routine purposes. If you have questions or concerns about privacy of your personal information and medical records, please call customer service.

Disenrollment Form

Medicare Advantage (Part C)

Appeals and Grievances:
Call (888) 298-4650, TTY 711.

Our hours are 8 a.m. to 8 p.m. CST, seven days a week from October 1–March 31; and Monday through Friday from April 1–September 30.

Mail the form to:
MyAdvocate Medicare Advantage
PO Box 8000
Marshfield, WI 5449-8000

Where can I find an appeal form?
Appeal form 

Medicare Advantage Part (D)
To file an appeal or grievance related to Medicare Advantage (Part D), please see section below titled: How do I request a coverage determination or medical exception for a drug?

What is an Appointment of Representative form?
If a member wants someone who is not already authorized under state law to act for them, the member and that person must sign and date an Appointment of Representative form to give that person legal permission to be an appointed representative.

How do I file a grievance?
You or your appointed representative can call the grievances phone number to file a grievance.

For more on this process, refer to “What to do if you have a problem or complaint (coverage decisions, appeals, complaints)” in your Evidence of Coverage.

What if I don’t want to file my complaint through MyAdvocate Medicare Advantage?
You can go directly to medicare.gov or call (800) MEDICARE (633-4227) to file a complaint.

You can also get help with Medicare-related complaints, grievances and information requests from the Medicare Beneficiary Ombudsman (MBO).

Access the Medicare Complaint Form

The coverage determination form can be sent to us via mail or fax. Please follow the instructions provided on the form. You may also ask us for a coverage determination by phone at (844) 504-5955 (TTY 711).

View the complete Prescription Drug Transition Policy.

What is the MTM Program? 

Medicare Advantage offers Medication Therapy Management (MTM) services at no additional charge to Medicare Advantage plan members with Part D coverage who meet Centers for Medicare and Medicaid Services (CMS) criteria. These services are provided in line with CMS guidelines and are not considered a benefit.

Medication Management Therapy (MTM) services

MyAdvocate Medicare Advantage’s MTM services are provided by specially trained MTM pharmacists. An MTM pharmacist will review all your medications and any over-the-counter and herbal products you use to identify and address medication problems. The MTM pharmacist may help you with the following:

• Medications not being used correctly
• Duplication of medications
• Unnecessary medications
• Medications needed for an untreated or inappropriately managed condition
• Organize your medication schedule
• Lower your risk for harmful drug reactions
• Lower-cost alternatives to your prescriptions, if appropriate, to reduce your out-of-pocket costs
• In-depth, education, consultation and advice provided to patients, family and/or caregivers to help assure proper use of medications

MTM pharmacists review medications being taken for many health conditions, including but not limited to rheumatoid arthritis, osteoporosis, congestive heart failure (CHF), diabetes, high cholesterol, high blood pressure, depression, asthma, chronic lung disorders, chronic obstructive pulmonary disease (COPD), Alzheimer’s disease, end-stage renal disease (ESRD), HIV/AIDS, schizophrenia, bipolar disorder, osteoarthritis and cerebrovascular disease.

Eligibility requirements to receive MTM services

General criteria:

• Must have three or more health conditions
• Must take eight or more chronic or maintenance drugs
• Part D costs must exceed $1,623 annually or $405.75 quarterly

Criteria for at-risk beneficiaries who use opioids from multiple prescribers/pharmacies

• Opioid use with average daily morphine milligram equivalents greater than 90 milligrams for any duration during the most recent six months AND either:
  • Must have three or more opioid prescribers AND three or more opioid-dispensing pharmacies
    - OR -
  • Must have five or more opioid prescribers (regardless of the number of opioid-dispensing pharmacies)
    • Prescribers within the same practice are counted as a single prescriber
    • Pharmacies with multiple locations that share real-time data are counted as one pharmacy
      
      
• History of opioid-related overdose:
  • A medical claim with a primary diagnosis of an opioid-related overdose within the most recent 12 months
    - AND - 
  • A Part D opioid prescription (not including medication-assisted treatment) within the most recent six months

Learn more about the MTM program

If you meet the eligibility criteria noted above, you will be enrolled automatically in MyAdvocate Medicare Advantage’s MTM program. You will receive a welcome letter and phone call within 60 days inviting you to participate. An MTM pharmacist will call you to complete a comprehensive medication review (CMR). The CMR usually takes 10-15 minutes. After speaking with you, the MTM pharmacist will follow up with your doctor, if necessary and with your permission, to resolve any problems with your medications.

Once you are enrolled in the MTM program, you or your prescriber may also be contacted about a targeted medication review (TMR) if an issue is identified with your medications that requires you or your prescriber's attention. TMR identifications are performed on a quarterly basis.

You will also receive a follow-up letter that includes a written copy of your medication action plan and your personal medication list to keep track of your medications. We encourage you to update this information with your doctors, pharmacists and other health care providers at every visit. You may also want to give copies to your family or caregivers. You can request additional copies by calling Pharmacy Services at the phone number below. Click the link below to see a blank copy of a personal medication list.

Regardless of which pharmacist performs your medication review, you may continue to use your regular pharmacy to fill your prescriptions.

Personal medication list

To Do list

Getting started is easy

To set up your appointment, simply call MyAdvocate Medicare Advantage’s Pharmacy Services at 1-866-978-4695 (TTY: 711).

What is Original Medicare?
Medicare is the government-run insurance program for those 65 and older or certain people with disabilities or end-stage renal disease (permanent kidney failure).

Medicare has four different parts, which can be mixed and matched through different plans to give you the coverage that’s right for you. They include:

• Medicare Part A
• Medicare Part B
• Medicare Part C (Medicare Advantage)
• Medicare Part D

What is Medicare Part A?
Medicare Part A, also called hospital insurance, covers:

• Inpatient hospital stays
• Skilled nursing facility stays
• Hospice care
• Nursing home care
• Home health care

What is Medicare Part B?
Medicare Part B is also known as medical insurance. It covers certain services from doctors, outpatient care, medical supplies and preventive care. These services fall under Medicare Part B:

• Physician services
• Ancillaries (lab work, X-rays, etc.)
• Therapy (PT, OT, SLP)
• Clinical research
• Ambulances
• Durable medical equipment
• Mental health care
• Limited prescription drugs

What is Medicare Advantage?
Medicare Advantage Plans, or Part C plans, are plans offered by private companies like MyAdvocate Medicare Advantage. These plans administer your Original Medicare.

Many plans include prescription drug coverage to combine Medicare Part A, Part B and Part D into one easy package.

What is Medicare Part D?
Medicare Part D is prescription drug coverage. You can buy Part D from insurance companies to go with your Original Medicare coverage or your Medicare Supplement coverage. You could also choose a Medicare Advantage plan that includes Part D prescription drug coverage.

You’re eligible for Original Medicare, Medicare Part A and Medicare Part B if you fit at least one of these criteria:

• Are age 65 or older
• Are disabled
• Have end-stage renal disease

To be eligible for a Medicare Advantage plan, you must:

• Have Medicare Parts A and B - Continue to pay your Medicare Part B premium if it’s not paid for under Medicare or by a third party
• Live in the plan’s service area

MyAdvocate Medicare Advantage offers free educational seminars and wellness events throughout the year.

View All Events