Medicare AdvantageCoverageHigh impact
20-936m 2021 Individual Medicare Advantage Plan Codes, Service Area Changes and Medicare Part D Formulary
Health Net·CA·Prior Authorization
Effective date
Jan 1, 2021
We identified it
Jun 20, 2026
Summary
Health Net Medicare Advantage plans updated service areas, plan codes, and formulary coverage effective January 1, 2021. Multiple medications are being removed from coverage with alternative options provided, requiring prior authorization requests for continued coverage of non-formulary drugs.
Action Required
Immediately: Review patient medications against the removed drug list and switch to formulary alternatives where appropriate. For patients requiring continued non-formulary drugs, submit Coverage Determination requests through ca.healthnetadvantage.com or call 1-800-867-6564. Update billing system with new Medicare Advantage plan codes by county from the 2021 flyer for accurate monthly reporting. Billing team must verify patient plan codes match updated county availability.