Member Resources

When you join Viva Medicare, you choose one doctor to be your Primary Care Physician (PCP).

You will use the specialists and hospital associated with your PCP when you need medical care. This is called your Provider System.

The Viva Medicare Provider Systems are listed below. Click on a Provider Directory to see a list of doctors and hospitals who are in that provider system. You may also use the "Provider Search" feature below to search by a doctor's last name or specialty.

Medication Therapy Management (MTM) is a patient-centered and comprehensive approach to help members understand their medications and use them safely. The Medication Therapy Management (MTM) Program is not a covered benefit of Viva Medicare. Rather, it is a program available, at no additional cost, to members who meet certain criteria. You will be automatically enrolled in the Medication Therapy Management Program if you meet ALL of the following three (3) criteria:

2021 MTM Program Criteria

1. Take eight (8) or more drugs from the following specific Part D drug classes:

   • Alpha Blockers
   • angiotensin-converting enzyme (ACE) inhibitors
   • angiotensin II receptor blockers (ARBs)
   • antihyperlipidemics
   • antihypertensives
   • beta blockers
   • calcium channel blockers
   • diuretics
   • insulins
   • oral hypoglycemics

   • bisphosphonates
   • digoxin
   • hydralazine
   • nitrates
   • vasodilators
   • abaloparatide
   • calcitonin salmon nasal
   • denosumab
   • romosozumab
   • teriparatide
   
   

2. AND Have three (3) or more of the following long-term health conditions:

   • Osteoporosis
   • Chronic Heart Failure (CHF)
   • Dyslipidemia

   • Diabetes
   • Hypertension
   
   

3. AND Have an anticipated annual drug spend of at least $4,376 for calendar year 2021 or $4,255 for calendar year 2020.

The Viva Medicare MTM Program offers a Comprehensive Medication Review (CMR) for all eligible members either face-to-face or over the phone. Members who meet eligibility requirements will be automatically enrolled and sent an invitation letter welcoming them to the program. After receiving the invitation letter, you will be contacted by a partnering local pharmacy, an MTM call center, or a Viva Medicare pharmacist or other qualified providers to schedule your medication review. A CMR takes about 30 minutes and is usually offered once each year. A specially trained pharmacist or other qualified provider will review your medication history, including prescription and over-the-counter medications, and identify and resolve any medication issues. Confirmed medication-related problems and recommendations may be communicated to your prescriber. Upon completion of the CMR, you will be mailed a Medication Action Plan that provides steps you should take to help you get the best results from your medications and a Personal Medication List that will help you keep track of your medications and how to use them the right way. You may obtain a blank copy of the Personal Medication List by clicking here.

You may choose to disenroll from the MTM Program any time during the year or you may decline individual services without having to disenroll from the program. In addition to the CMR, all MTM eligible members will also receive a Targeted Medication Review (TMR). The pharmacy claims of all members who qualify for MTM will be reviewed every three months to identify any new or persistent drug therapy problems, such as the presence of potential safety problems and/or gaps in care involving adherence to chronic medications and omissions in care. If the TMR analysis identifies any issues, then follow-up intervention opportunities are communicated to your prescriber(s) via fax or mail.

For more information on Viva Health Medicare MTM Program, please contact our member services department at 1-800-633-1542 or 205-918-2067, TTY users call 711. The hours are Monday-Friday, 8 am - 8 pm. From October 1st through March 31st, seven days a week, 8 am - 8 pm.

You can name (appoint) someone to file a (grievance) or appeal for you. This person you name would be your representative. To appoint a representative, complete the appropriate form below and mail (417 20th Street North, Suite 1100, Birmingham, AL 35203) or fax (205-558-7414) it to Member Services.

The Centers for Medicare & Medicaid Services (CMS) sometimes changes the coverage rules that apply to an item or service under Medicare. Such changes may include what benefits and services are covered, what benefits and services are changing, and what Medicare will pay for an item or service. When this happens, CMS issues a National Coverage Determination or NCD. You can view the CMS annual database where all NCDs are posted by year here.

^† Premium amount depends on county of residence

Members continue to pay the Part B premium to Medicare. Members who enrolled in a Medicare Part D prescription drug benefit after their initial eligibility period may have to pay a late enrollment penalty imposed by Medicare.

If you are a current Viva Medicare member and would like to change to one of our other Viva Medicare plans, complete the Plan Change form below and mail it to the address listed at the bottom of the form. Please be aware that you can change plans only at certain times during the year. Between October 15th and December 7th each year, anyone can change plans. Generally, you may not make changes at other times unless you meet certain special exceptions, such as if you get Extra Help for prescription drugs or qualify for a Medicaid program.

Some people with Medicare can get extra help with prescription drug costs and their monthly plan premiums. If eligible, your monthly plan premium will generally be lower once you receive extra help from Medicare. Persons eligible for Medicaid, Supplemental Security Income (SSI), or a Medicare Savings Program qualify for the extra help automatically and do not need to apply. All others may apply with the Social Security Administration by mail, by telephone (1-800-772-1213), or at: http://www.socialsecurity.gov.

Applications may also be filed at a local Medicaid office. Medicare Part D will provide a full subsidy with low co-payments to Medicare beneficiaries with incomes up to 135% of the Federal Poverty Level (FPL) and limited resources. Medicare Part D will provide a partial subsidy of premium, deductible, and co-insurance to Medicare beneficiaries with incomes up to 150% of the FPL and limited resources.

In some instances, CMS systems may show that you are not eligible for the low income subsidy (LIS) or extra help even though you are. Viva Medicare is required to accept evidence that you present despite it contradicting the information received from CMS. You can view the Centers for Medicare & Medicaid Services webpage here about the evidence you may submit to show your eligibility for the low-income subsidy (also known as Best Available Evidence).

The table below shows what your monthly premium will be for Viva Medicare Plans if you are currently on LIS. The premiums listed do not include any Part B premium that you may have to pay. The premiums listed in the table are for both medical services and prescription drug benefits.

Viva Medicare Extra Value, Viva Medicare Extra Care, Viva Medicare Me, Viva Medicare Classic, and Viva Medicare Plus - Segment 1

Viva Medicare Plus - Segment 2

Viva Medicare Premier

Viva Medicare Prime

Viva Medicare Preferred

A complaint (grievance) does not involve a coverage decision. You can file a complaint (grievance) if you have any type of problem with Viva Medicare or one of our network providers.

To make a complaint (grievance), please call Member Services (see contact information below). You can also complete the Consumer Affairs form linked here and mail or fax the form to Member Services (see contact information below). Please see Chapter 9 of your Evidence of Coverage for your plan above.

You have the right to contact Medicare and file a complaint about your coverage decision. You may contact Medicare to file your complaint by clicking here and by following the instructions on the form.

While you are a member of our plan, you must continue to get your Medicare covered services through Viva Medicare.

• You should continue to use the Viva Medicare network of pharmacies to get your prescriptions filled (if you have prescription drug coverage through our plan).
• If you are hospitalized on the day your membership ends, your hospital stay will usually be covered by Viva Medicare until you are discharged.