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Hours of Operation
PremierCare Customer Service
Monday through Friday, 8 am to 8 pm
During the Annual Election Period (October 15 - December 7), hours 8 am 8pm, 7 days a week
Portland metro: 503-345-5702
Toll-Free: 866-798-CARE (2273)
TTY: 800-735-2900
Basic Part C Questions/Pre-existing Conditions/Low Income Subsidy (LIS)
1. What are Medicare Parts A through D?
“Part C” is another term for Medicare Advantage. Medicare Advantage plans combine the benefits of Medicare Part A (hospital insurance) and Medicare Part B (medical insurance) in a single plan. Medicare Advantage plans usually (but not always) include Medicare Part D (prescription drug coverage), too. Medicare Advantage Plans are NOT the same thing as supplemental coverage.
2. My parents are turning 65 in a few months. When can they first enroll in your plan?
You can enroll up to 3 months before the month that you’re entitled to Medicare Part A and Part B. For example, if your 65th birthday is in July, you can enroll as early as April 1.
3. Would I qualify for any additional assistance from Medicare?
There are subsidies available for qualified low-income individuals if you meet certain income and resource limits. Please call Social Security at 800-772-1213 to apply by phone or get a paper application to see if you qualify.
4. What is a Low-Income Subsidy?
There is “extra help” (also called a “low-income subsidy”) to help people with Medicare who have limited income and resources pay for Medicare prescription drug coverage. If you qualify for extra help, you will get help paying for your Medicare drug plan’s monthly premium. It will also help you pay for some of the costs you would normally pay for your prescriptions. The amount of extra help you get will be based on your income and resources. You can apply for extra help by calling Social Security at 800-772-1213 (TTY 800-325-0778) or visiting www.socialsecurity.gov.
5. My father had cancer in the past. Can he still join one of the PremierCare plans?
Yes
6. Will you still take me if I have a pre-existing condition?
The only pre-existing condition that will keep you from qualifying for our plan is End Stage Renal Disease (ESRD).
7. Does your plan require new members to pass a physical exam in order to join?
No
8. If my dad joins your plan and stays with it next year, will he be required to pass a physical exam next year to keep his coverage in the plan?
No
9. Will my dad lose his Medicare if he joins a Medicare Advantage plan?
No. Your dad will not lose his Medicare benefits. He will get his Medicare benefits through our Medicare Advantage plan.
10. I know my dad has Medicare Part A. Does he also need to be enrolled in Part B to join a Medicare Advantage plan?
Yes
11. Do I have to keep paying for Medicare Part B when I join your plan, and why?
All Medicare Advantage members must have Part B coverage. Unless Medicaid pays your Part B premium for you, you will still have to pay your Part B premium.
Most people do not pay a premium for Medicare Part A (Hospital). Unless you’re one of the few people who pay a Part A premium, you will not have to pay the Part A premium to join one of our PremierCare plans.
Your copy of Medicare & You 2012 tells about these premiums in the sections called “How Much Does Part A Coverage Cost?” and “How Much Does Part B Coverage Cost?” This explains how the Part B premium differs for people with different incomes.
Everyone with Medicare receives a copy of Medicare & You each year in the fall. If you’re new to Medicare, you should receive it within a month after you sign up. You can also download a copy of Medicare & You 2012 from the Medicare website, www.medicare.gov. Or, you can order a printed copy by phone at 800-MEDICARE (800-633-4227) 24 hours a day, 7 days a week. TTY users call 877-486-2048.
12. What is a “Medigap policy” or “Medicare Supplement Insurance?”
The terms “Medigap” and “Medicare Supplement Insurance” mean the same thing; they are private insurance plans that help pay some of the healthcare costs that original Medicare doesn’t cover. They are NOT the same thing as a Medicare Advantage plan, which provides recipients with all of their Medicare benefits.
13. Can my dad use a Medigap policy to pay for a Medicare Advantage plan’s out-of-pocket costs, like co-pays?
If you join our Medicare Advantage Plan, you don’t need a Medigap policy. If you already have a Medigap policy, you can’t use it to pay for co-payments, deductibles or premiums. You may want to drop the Medigap policy, also known as supplemental insurance. Furthermore, if you already have a Medicare Advantage Plan, you can’t purchase a Medigap policy unless you’re switching back to Original Medicare.
14. If I have a Medicare Advantage plan, why shouldn’t I get a Medigap policy, too?
Medicare Advantage plans generally cover many of the same benefits that a Medigap policy would cover, such as extra days in the hospital beyond the original Medicare benefit.
15. My dad is turning 65 next month. Does he have to join the same Medicare Advantage plan as my mom or can he stay in regular Medicare?
He can choose a different Medicare Advantage plan or he can stay with Original Medicare.
16. Why do I need to have Medicare to qualify for your plan?
We have a contract with Medicare. Our contract only lets us enroll people who have Medicare Part A and Part B.
17. Can my dad enroll in multiple Medicare Advantage plans?
No. Medicare will only let people enroll in one Medicare Advantage plan at a time.
18. What is the difference between all your plans?
Different plans have different premiums, co-pays, co-insurance and deductibles. Some of the benefits are different for different plans.
19. I’m not a PremierCare member, but I want to know more about your Medicare Advantage plans. Can you send me information?
Yes. We have an enrollment kit that can answer your questions about our PremierCare Medicare Advantage plans. Contact Customer Service at 866-798-CARE (2273), TTY users call 800-735-2900, Monday to Friday, 8 am to 8 pm.
20. I am a member of a PremierCare Medicare Advantage Plan. How can I get more information about my benefits, cost-sharing or the formulary?
All of these documents are available online. Click your PremierCare plan name, to the left, and you will be able to see the Evidence of Coverage, Formulary, Provider/Pharmacy Directory and other important documents.
You should have received copies of an Evidence of Coverage, Formulary and Provider/Pharmacy Directory in the mail. If you haven’t received them or can’t locate them, you can review the information online by using the link mentioned above or by calling Customer Service at 866-798-CARE (2273), TTY users call 800-735-2900, Monday to Friday, 8 am to 8 pm.
21. Is there any way I can find the information online?
Yes. All of these documents are available on this website by clicking the link to the PremierCare plan you’re interested in and then clicking the link to the document you’re interested in viewing. For example, to view the Summary of Benefits for Choice Rx, click PremierCare Choice Rx in the left column, then the Summary of Benefits on the page that opens.
Premiums/Benefits/Co-pay Questions/Authorizations
1. My father does not get extra help and he is not on Medicaid. What is his monthly Premium?
· PremierCare Value Rx/Plan 014................................................. $125 per month
· PremierCare Choice Rx/Plan 003................................................. $74 per month
· PremierCare Choice/Plan 004....................................................... $49 per month
If he qualifies for Low Income Subsidy (LIS), this may reduce the monthly premium. Contact Customer Service at 866-798-CARE (2273), TTY users call 800-735-2900, Monday to Friday, 8 am-8 pm, to learn more. Please have the Member’s ID Number ready when you call.
2. What happened to PremierCare Select Rx?
FamilyCare will not be renewing PremierCare Select Rx effective January 1, 2012.
From October 15th through February 29, 2012, Select Rx members have the option of enrolling in another plan for 2012. They can enroll in a Medicare Advantage plan, a Section 1876 cost plan, or a Part D plan. However, if you want your new plan to take effect on January 1st, the new plan must receive your application by December 31st.
If your new plan receives your application in January, your new plan will take effect on February 1, 2012. If your new plan receives your application in February, your new plan will take effect on March 1, 2012.
3. What happened to PremierCare Advantage Rx?
FamilyCare will combine PremierCare Advantage Rx with PremierCare Value Rx effective January 1, 2012. If you are an Advantage Rx member, you will become a Value Rx member.
You do not have to complete any paperwork or do anything else if you wish to become a member of Value Rx.
4. If my dad has to pay a premium for your plan, he wants it withheld from his Social Security check. How long should he wait after he elects to have premiums withheld before calling back to determine if there is a problem with the withholding?
It can take up to three months for Social Security withholdings to begin. If funds are not drawn by this time, we will contact you directly.
Knowledge Note: PremierCare Premiums are due by the 10th of each month. There are three payment options:
a. Coupon book—Members receive a coupon book and postage-paid envelopes. They use these “coupons” and envelopes to send in a check or money order each month.
b. Quick Pay—Members can have their premium automatically deducted from a checking or savings account each month. The premium is deducted from between the 5th and 10th of each month.
Members complete a Quick Pay Form and return it with a voided check (or savings account information). If FamilyCare receives the form by the 20th of the month, Quick Pay can start the following month.
c. Social Security Deduction—Members can have their premium deducted from their monthly Social Security payment. If members are covered by the Railroad Retirement Board, they can also have their premium deducted from their monthly RRB payment.
5. What is my cost for Ambulance services?
The co-pay for ambulance is $100 per trip. If you are admitted to the hospital for an inpatient stay, then the co-pay is waived. However, the co-pay for members of our Medicaid/Medicare plan (PremierCare Plus) is $0.
6. How do I ask FamilyCare to repay me for a bill I’ve received?
Send us your request for payment, along with your bill and documentation of any payment you have made. It’s a good idea to make a copy of your bill and receipts for your records.
7. Does your PremierCare plan cover routine eye exams?
Yes. All of our plans cover one routine eye exam each year.
8. What vision provider can I use for routine services?
Members can go to any eye doctor or optical store that is a member of the Vision Service Plan (VSP) network. VSP is a nationwide network with 56 million members. Search the network by visiting the VSP website, www.vsp.com.
9. Do any of your plans cover preventive dental cleaning?
No, not at this time.
10. How much do I pay if I am in the hospital?
It depends on your plan and whether you are seen as an inpatient or an outpatient. This information is available in the Evidence of Coverage on this website. Simply click the link to your PremierCare plan name on the list to the left then, once on the PremierCare plan page, click the link to the Evidence of Coverage and search for specific co-pays.
11. How much do I pay if I need a hospice or home healthcare?
Hospice costs are covered by Original Medicare. The co-pay for a home health visit is $20. However, members of PremierCare Plus have a $0 co-pay for home health visits.
12. If my father gets sick in the middle of the night or on the weekend and he goes to the nearest emergency room, will he be covered?
Yes.
13. What does it cost to go to the emergency room?
The co-pay for emergency care is $50.
If you go to the emergency room and are admitted to the hospital, the emergency room co-pay is waived. However, members of PremierCare Plus have a $0 co-pay for emergency room visits.
14. What is my co-pay for durable medical equipment like a wheelchair?
You pay 20% of the contract-allowed cost.
15. Do I need a referral for non-emergency, acute inpatient hospital visits?
Yes. Any inpatient stay needs to be approved in advanced unless it’s for an emergency.
Service Area Questions/HMO vs PPO/Provider Directory Questions
1. What doctor or clinic is closest to me?
You can search for this information by visiting the A Doctor or Other Healthcare Provider page and searching for a provider or clinic near your zip code or click Provider/Pharmacy Directory to view a copy of the directory.
2. How do I find a network doctor?
You should have received a copy of the Provider/Pharmacy Directory in the mail. It lists doctors in our network. If you haven’t received the directory or can’t find it, you can see a copy by clicking Provider/Pharmacy Directory. You can also click A Doctor or Other Healthcare Provider to search for doctors by name or by location.
3. How do I find a network pharmacy?
You should have received a copy of the Provider/Pharmacy Directory in the mail. It lists doctors in our network. If you haven’t received the directory or can’t find it, you can see a copy by clicking Provider/Pharmacy Directory.
4. What counties does the plan serve?
You can enroll in a PremierCare plan if you live in Clackamas, Clatsop, Morrow, Multnomah, Umatilla or Washington county.
5. Does the PremierCare provider directory include primary care providers?
Yes.
6. Is PremierCare an HMO or PPO? What type of health plan is this?
FamilyCare Health Plans is an HMO.
7. What is the difference between an HMO and PPO?
“HMO” stands for health maintenance organization. With our HMO, you see doctors or other healthcare providers who are members of our provider network. You’ll have a primary care provider who takes care of most routine medical needs.
You can see any provider in our network without prior authorization, including specialists. If you want to go to a doctor outside of our network, you need to get prior authorization from our plan.
“PPO” stands for preferred provider organization. You can see any doctor you want, but you’ll pay more if you see a doctor who is not a member of the PPO network.
8. What hospitals can I go to?
Use the Provider/Pharmacy Directory to find hospitals that are in our network or search online by clicking A Doctor or Other Healthcare Provider. You can go to any hospital that accepts Medicare patients as long as they are willing to bill FamilyCare for care.
9. Will I be covered outside the plan’s service area?
Our plans cover emergency service and dialysis anywhere in the US. If your plan includes Part D coverage, you can fill prescriptions anywhere in the US.
Our plans also cover emergency care anywhere in the world. However, members of PremierCare Plus do not have worldwide coverage.
Knowledge Notes: A “medical emergency” is when you—or any other prudent layperson with an average knowledge of health and medicine—believe that you have medical symptoms that require immediate medical attention to prevent loss of life, loss of a limb, or loss of function of a limb. The medical symptoms may be an illness, injury, severe pain, or a medical condition that is quickly getting worse.
10. Can my PCP refer me to a non-contracted /out-of-network provider?
You need an authorization to see an out-of-network provider. Your PCP’s office can contact FamilyCare for you.
11. Do I need approval to see contracted network specialists?
No. However, any services you receive must be covered by your plan. Some services may require prior authorization.
12. How long can I be out of state visiting before I lose my coverage?
If you are outside of our service area for six consecutive months, we are required by CMS to disenroll you from our plan.
13. Do you have doctors who speak my language?
We have providers who speak a variety of languages, including Spanish, Vietnamese and Russian. If we do not have a provider who speaks your language, we have interpreter services that we can schedule for onsite appointments.
14. My mother is moving into an assisted living community in her neighborhood. Can she still join PremierCare?
Yes, as long as she still resides in our six-county service area: Clackamas, Clatsop, Morrow, Multnomah, Umatilla and Washington counties in Oregon.
Disenrollment/Reinstatement Questions:
1. When can I end my membership with your plan?
In most cases, you must stay enrolled through the end of the calendar year.
During the Annual Election Period each year from October 15th through December 7th, you can change Medicare Advantage plans or disenroll and return to Original Medicare. You can also disenroll during the Medicare Advantage Disenrollment Period (MAPD) From January 1st through February 15th.
However, in certain situations, you may be able to join, switch or drop a Medicare Advantage plan at other times. Some of these situations include:
1. If you move out of your plan's service area.
2. If you have both Medicare and Medicaid.
3. If you qualify for Extra Help to pay for your prescription drug costs.
4. If you live in an institution (like a nursing home).
2. How do I end my membership in your plan?
Usually, to end your membership in our plan, you simply enroll in another Medicare Advantage plan or in a Section 1876 cost plan during a Medicare enrollment period. (You will not be automatically disenrolled if you enroll in a Medigap plan.) If you want to disenroll without enrolling in a different plan, you can speak to our Sales Department by calling 866-225-CARE (2273), TTY users call 800-735-2900, Monday through Friday, 8 am to 8 pm, or notify us in writing.
3. If I elect to end my coverage, how long will I be covered by your plan?
Once we receive a Medicare-permitted request to end coverage, we will continue to cover you to the end of the month. For example, if we receive your request to disenroll on July 15th, we will cover you through July 31st.
4. If I switch to another plan, how long will I be covered by your plan?
It depends on whether you switch during the Annual Election Period (AEP) or during a Special Enrollment Period (SEP).
If you switch during AEP, we will continue to cover you through December 31st. Your new plan will take over your coverage on January 1st.
If you switch during an SEP, we will cover you through the end of the month when we receive notice of the change. For example, if we receive notice on July 15th that you are changing plans, we will cover you through July 31st.
5. What if I am hospitalized on the day my membership ends?
In most cases, we will continue to cover your hospital stay until you are discharged—even if you are discharged after your new coverage begins.
6. Can you ask me to leave your plan?
No. If you feel that you are being asked to leave our plan because of a health-related reason, you should call Medicare at 800-MEDICARE (800-633-2273). They are available 24 hours a day, 7 days a week.
Part D Questions, Co-pays, Deductible/Coverage Gap vs. Catastrophic Coverage
1. What do you pay for a Part D vaccination?
PremierCare covers 100% of the cost of the vaccines for flu, pneumonia and hepatitis B under our preventive services benefit. Other vaccines—like the vaccines for shingles or tetanus—are covered under Medicare Part D. You may have to pay a deductible or co-pay for Part D vaccines.
The simplest way to get your immunization is to go to a network pharmacy and ask the pharmacist to give you your shot. That way, you won’t have a co-pay for a doctor’s visit.
You can also get the vaccine at a pharmacy and take it to the doctor to get your shot. If you do this, you’ll pay a co-pay or co-insurance for the office visit.
Another option is to get both the vaccine and the shot from your doctor. If you do this, you’ll pay the doctor for the full cost of the vaccine, plus any co-pay for the office visit. Then you can ask us to reimburse you for the cost of the vaccine (minus any co-pay for a Part D vaccine).
2. How much do I pay out-of-pocket for a prescription?
How much you pay depends on your plan and the prescription. The PremierCare plan page will have a link to the Evidence of Coverage and Formulary, which will help you determine a co-pay for a drug.
3. What is the Coverage Gap Stage (donut hole)?
· The coverage gap (or donut hole) is one of four different drug stages. The deductible is stage 1.
· After you reach your deductible limit, you enter the initial coverage stage, or stage 2. The plan pays its share of the cost of your drugs and you pay your share of the cost. You stay in this stage until your “total yearly drug costs” reach $2,930.
Total yearly drug costs include everything you’ve paid – including deductibles and co-pays – plus everything the plan paid.
· Once your total year drug costs reach $2,930, you enter stage 3. This is called the coverage gap or “donut hole.” In this stage, the plan does not cover your drug costs, but you get discounts on generic and brand name drugs. You pay 50% of the cost of brand name drugs and 86% of the cost of generics.
You stay in the donut hole until your total out-of-pocket costs reach $4,700. Total out-of-pocket drug costs include everything you have paid for, including the deductible, co-insurance and co-pays.
· Once your total out-of-pocket costs reach $4,700, you enter stage 4, the catastrophic coverage stage. In this stage, you pay the greater of
o 5% co-insurance OR
o $2.60 for generic drugs and $6.50 for all other drugs
Knowledge note: PremierCare Plus (our “dual plan” for people with Medicaid and Medicare) has only two stages. There is no deductible and no “donut hole.” As soon as the total out-of-pocket costs reach $4,700, you enter the catastrophic coverage stage.
4. Does your plan cover generic drugs in the Coverage Gap?
No, but you receive a discount on generics and brand-name drugs. Keep using your FamilyCare plan card. Using your card each time you fill a prescription ensures that you will get the correct coverage and manufacturer discounts applied to your prescriptions and that the money you spend counts toward your out-of-pocket costs.
5. If I do not get extra help and I’m not on Medicaid, what is my plan’s yearly drug deductible?
· PremierCare Value Rx—$100
· PremierCare Plus—$0
· PremierCare Choice Rx—$190
· PremierCare Choice—does not cover Part D prescription drugs.
6. If I already paid for my deductible, then what are my costs for generic and preferred brand name prescriptions for 30 day supply?
· PremierCare Value Rx – $7 for a 30-day supply of generics, $30 for preferred brand and some generic drugs, $70 for brand name drugs, and 30% of the cost for specialty drugs.
· PremierCare Choice Rx – $7 for a 30-day supply of generics, $30 for preferred brand and some generic drugs, $65 for brand name drugs, and 28% of the cost for specialty drugs.
· PremierCare Choice does not cover Part D drugs.
· PremierCare Plus – co-pays for people with Medicaid and Medicare coverage vary depending upon the Low Income Subsidy (LIS) level. For generic drugs, the co-pay can be $0, $1.10 or $2.60. For all other drugs, the co-pay can be $0, $3.30 or $6.50.
7. How do I know what drugs are covered?
Members should have received a Formulary in the mail. You can also click the “Part D Drug List (Formulary)” link on this website to view the Formulary online.
8. I currently have prescription drug coverage with another plan. How will I know if my prescription drugs will be covered under your plan?
You can compare your current prescription drugs to the drugs listed in our Formulary, which members received in the mail. If you aren’t a member or you don’t have your Formulary, you can see it online by clicking Part D Drug List (Formulary).
9. What can I do if I join your plan and my prescriptions are not covered, if the Formulary changes or if my drug is restricted in some way?
You can change to another drug. In some situations, you may be able to get a temporary supply of the drug. This will give you and your provider time to change to another drug or to file a request to have the drug covered. Or you can request an exception and ask the plan to cover the drug or remove restrictions for the drug.
If you ask for an exception, your provider must submit a statement supporting your request. The provider’s statement must indicate that:
· The requested drug is medically necessary for treating your condition and none of the drugs we cover would be as effective as the requested drug.
OR
· None of the drugs we cover would be as effective as the requested rug.
OR
· The drugs that we cover would have an adverse effect for you.
If you’re requesting an exception because of a prior authorization, quantity limit or other restriction we have placed on the drug, the provider must indicate the restriction would:
· Not be appropriate given your condition.
OR
· Would have adverse effects for you.
You can request an exception in writing. You can mail a written request to FamilyCare Health Plans at 825 NE Multnomah St., Suite 300, Portland, OR 97232, or fax it to us at 503-471-2176. You can reach us by calling 866-798-CARE (2273), TTY users call us toll-free at 800-735-2900. Our hours are 8 am to 8 pm, Monday through Friday.
10. Does your plan cover seasonal flu shots?
Yes
11. Is a tetanus shot covered by part D?
Yes
12. What is Medication Therapy Management (MTM) and how can I enroll your MTM program?
Medication Therapy Management is a voluntary program for members who take multiple medications for a chronic condition such as high blood pressure, high cholesterol, diabetes or asthma. There is no co-pay or co-insurance for MTM.
If you are in the MTM, we look at all your prescriptions to make sure you’re not being over-medicated and that your drugs work properly with each other. A pharmacist may call you to talk about all of the drugs you take, including any over-the-counter medications.
If you are interested in enrolling in the MTM program, please call Customer Service at 866-798-CARE (2273). TTY users call 800-735-2900. We are available Monday to Friday, 8 am to 8 pm. To learn more, click Drug Management & Safety.
13. What is a Formulary?
The Formulary is a list of drugs that we cover. It also tells what tier a drug is in and whether it’s subject to quantity limits, step therapy or prior authorization rules. Medicare reviews and approves our Formulary, which is available by clicking the link Part D Drug List (Formulary).
14. What does QL stand for on my formulary?
“QL” stands for “Quantity Limit.” For safety or other reasons, we limit the amount of a drug the pharmacy can issue. A quantity limit can affect the amount of drug or the length of time. (For example, 120 tablets per 30 days)
15. What does PA mean?
“PA” stands for “Prior Authorization.” Prescriptions for drugs marked “PA” must be approved by the plan in advance in order to be covered. You can see a list of the drugs which require prior authorization by clicking the link to the PremierCare Plan you’re interested in and clicking the Prior Authorization link.
16. What does ST mean?
“ST” stands for “Step Therapy.” If a drug is marked “ST,” you have to try one or more other drugs before the plan will cover the step therapy drug. You can see a list of the drugs which are part of the step therapy program by clicking the link to the PremierCare Plan you’re interested in and clicking the Step Therapy link.
17. What if a medication is not on the Formulary?
If the drug is not in the Formulary, it is not covered by our plan. Your provider may find a covered drug that meets your medical needs and is effective for you. Your provider can ask the plan to make an “exception” and cover the drug.
18. Can I find quantity limit days supply information for your Formulary drugs on this website?
No, but you can call Customer Service at 866-798-CARE (2273), TTY users call 800-735-2900, Monday to Friday from 8 am-8 pm. You can also have your doctor call our pharmacy support department. That number is 503-471-2126. Your doctor can also call pharmacy support toll-free at 800-335-3205, Extension 2126. The pharmacy support department is available Monday to Friday from 8 am to 5 pm.
19. If a drug is going to be removed from your Formulary, how will I find out? How much advance warning will I get?
If we remove your drug from our Formulary, we will notify you at least 60 days before the change becomes effective, or when you request a refill (at which time you will receive a 60-day supply).
Formulary Change Notices will also be available online, once they are available.
20. What if I use up my prescription before my next refill date? Will I be able to get another refill?
It depends on the drug. Some drugs will require a prior authorization if there is a quantity limit and you go over this limit.
21. If someone steals my medication or if my house got flooded, could I replace my prescription without waiting?
Yes.
22. Where do I get my diabetic supplies?
You can purchase supplies for delivering insulin to the body from pharmacies or DME suppliers in our network. These supplies include syringes, needles, alcohol swabs, gauze, insulin pens and supplies, and needle-free syringes. These are automatically processed as a Part D benefit under Medicare.
For other kinds of supplies, we prefer that you order them from one of the durable medical equipment (DME) companies in our provider network. These supplies include lancets, glucose meters and test strips, and drugs used by external or implanted pumps. In some cases, these drugs may be covered through a pharmacy. However, the co-insurance may depend on whether you get these at a pharmacy or DME company.
Knowledge note: Network pharmacies and DME providers are both listed in the Provider/Pharmacy Directory, click the Provider/Pharmacy Directory or A Doctor or Other Healthcare Provider link to see a list of network pharmacies or search for one near you.
23. I think I may qualify for extra help for prescription drug coverage from the Social Security Administration. Do you know where I could get information about extra help?
Medicare provides “Extra Help” to pay prescription drug costs for people who have limited income and resources. To see if you qualify for getting Extra Help, call:
· 800-MEDICARE (800-633-4227). TTY users should call 877-486-2048, 24 hours a day, 7 days a week.
· The Social Security Office at 800-772-1213, from 7 am to 7 pm, Monday through Friday. TTY users should call 800-325-0778.
· The Oregon Health Plan (Medicaid) toll-free at 800-527-5772. TTY users can call 800-375-2863 toll-free.
24. What are the advantages of using the mail-order pharmacy?
For most drugs, if you order a 90-day supply of drugs through our network mail-order pharmacy, you only pay for a two-month supply. Our network mail-order pharmacy is CVS Caremark.
You also don’t have to make a special trip to the pharmacy because your drugs are delivered to your mailbox.
25. My mom just got onto Medicaid. Could she pay less for her prescriptions right away if she gives a copy of the Medicaid eligibility letter to the pharmacy?
Customer Service will ask the member to send in the Award letter from their Social Security Office so the Enrollment Department can update their Low Income Subsidy (LIS) list. Once we receive this award letter, there is a 24 hour turnaround time for the update. Please contact Customer Service by calling 866-798-CARE (2273) Monday through Friday from 8 am to 8 pm.
26. I will be visiting a friend out of state for a month and I’ll need to fill my prescription while I’m there. Do you have any network pharmacies in other states?
Yes, we have network pharmacies nationwide. Our network includes Albertsons, Bi-Mart, Costco, Fred Meyer, Rite Aid, Safeway, Target, Walgreen and Wal-Mart. You can go to any pharmacy that is part of the CVS Caremark system.
Before you go on your trip, we recommend that you get a copy of your prescription from your provider.
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