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HealthChoice Frequently Asked Questions
What is Medicaid?
Medicaid is a program for people with low income who meet certain eligibility requirements and programs can vary from state-to-state.
What is Medicare?
Medicare is a federal health insurance program for people who are age 65 or older, disabled persons, or those with end-stage kidney disease. Medicare eligibility is not based on income, and basic coverage is the same in each state.
What documents will I need when I apply for Medicaid?
When you apply for Medicaid, you must fill out an application form. You will also need to have various documents:
- Household monthly income (including pay stubs, W-2 forms, or tax returns if you have them)
- Social Security numbers or document numbers for each household member reapplying for coverage
- Date of birth for each household member reapplying for coverage
- Immigration information, if applicable
- Additional information as requested
What is the Prescription Drug Explanation of Benefits (EOB)?
The Explanation of Benefits is a document you will get each month you use your prescription drug coverage. It will tell you the total amount you have spent on your prescription drugs and the total amount we have paid for your prescription drugs. You will get your Explanation of Benefits in the mail each month that you use the benefits that we provide.
How is a "medical emergency" defined?
A "medical emergency" is when you reasonably believe that your health is in serious danger – when every second counts. A medical emergency includes severe pain, a bad injury, a serious illness, or a medical condition that is quickly getting much worse.
What should I do if I have a medical emergency?
If you have a medical emergency:
- Get medical help as quickly as possible. Call 911 for help or go to the nearest emergency room, hospital, or urgent care center. You don’t need to get approval or a referral first from your primary care doctor or other plan provider.
How to get urgently needed care?
If, while temporarily outside the Plan’s service area, you require urgently needed care, then you may get this care from any provider. The plan is obligated to cover all urgently needed care at the cost-sharing levels that apply to care received within the Plan network.
What if I use non-plan providers to receive services that are "covered"?
You must obtain covered services from network providers except in limited cases such as emergency care, urgent care, or when our network is not available. If you get non-emergency care from non-network providers without prior authorization, you must pay the entire cost yourself.
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