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Will CHC affect my Medicare

Note: The following information is from the Pennsylvania department of human services

Community HealthChoices will not change your medicare coverage.

Medicare is a federal health insurance program. It is your primary insurance and covers most of your health care services, including prescription drugs.

You also have another insurance called Medicaid. In Pennsylvania, Medicaid is known as “Medical Assistance”. You currently get your Medical Assistance coverage through the ACCESS card. Medical Assistance is your secondary coverage. It helps with Medicare costs and gives you additional benefits. When you have both Medicare and Medical Assistance, you are a dual eligible.

CHC will only change how you receive your Medical Assistance coverage. When you join CHC, you will choose one of three CHC plans: AmeriHealth Caritas Pennsylvania, PA Health & Wellness, and UPMC Community HealthChoices. Starting in January 2019, the CHC plan you choose will become your new secondary Medical Assistance coverage.


Does my Docotor or Primary care practitioner (PCP) have to be in the CHC Network?

No. — If you have a PCP that is not in your CHC plan’s network, you can keep this doctor. Your PCP will need to be enrolled in the PA Medical Assistance Program for the CHC plan to be able to pay for any services.

Please note: that your CHC plan may assign you to a PCP in their network. But, you would only need to use this CHC-PCP for services that are not covered by Medicare.


Can I see other medical providers that are not in my CHC plan network?

Yes. — When you receive any Medicare covered services, your CHC plan can pay the provider as long as the provider is enrolled with the PA Medical Assistance Program. For services that are not covered by Medicare (such as dental care or eye exams), you will likely need to use a provider that is in your CHC plan’s network. Your CHC plan can help you figure out what services Medicare covers.


Do I need to make changes to my Medicare?

You may choose to change your Medicare, but you do not have to. One of the goals of CHC is to have your Medicare and Medical Assistance work better together. No matter what Medicare coverage you have, your CHC plan will work with your Medicare and providers. If you would like to make any changes to your Medicare coverage, an APPRISE counselor can help you. Call 1-800-783-7067. As a dual eligible, you can change your Medicare coverage at any time during the year. If you do not know what Medicare coverage you have, please call APPRISE at 1-800-783-7067 or the Pennsylvania Health Law Project at 1-800-274-3258.

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