Health Care Coverage For Members With Florida Medicaid
Community Care Plan has a contract with the Florida Agency for Health Care Administration to provide health care services to people with Medicaid in Broward County. This is called the Statewide Medicaid Managed Care Program.
If you have been approved for Medicaid and are a Community Care Plan member, this page contains helpful information about the resources available to you.
Community Care Plan is a managed care plan with a Florida Medicaid contract in Broward County.
Original Medicare + Medigap And Part D Vs A Medicare Advantage Plan
Many people struggle to choose between Original Medicare and Medicare Advantage. The truth is, the better choice depends entirely on your needs.
If you travel often, have residences in two different states, or simply prefer the freedom of no provider networks or referrals, you may prefer to stick with Original Medicare. Dont forget to add a Part D prescription drug plan to your coverage, though, or you could face lifelong late enrollment penalties. You may also want to consider adding a Medigap plan, which will pay some of your costs for covered Medicare services . This is important since there is no annual out-of-pocket max with Original Medicare.
Your other option is a Medicare Advantage plan. In addition to the same services covered by Original Medicare, over 90% of Advantage plans offer extra benefits. The most common are:
- Fitness programs like SilverSneakers
- Routine vision and dental services
What Medicaid Helps Pay For
If you have Medicare and qualify for full Medicaid coverage:
- Your state will pay your Medicare Part B monthly premiums.
- Depending on the level of Medicaid you qualify for, your state might pay for:
- Your share of Medicare costs, like deductibles, coinsurance, and copayments.
- Part A premiums, if you have to pay a premium for that coverage.
Also Check: Does A Trust Protect Assets From Medicaid
Not Sure If You Are A Member
If you are approved for Medicaid and not sure if you are a Community Care Plan member, you can speak with a choice counselor to find out which care plan you are enrolled in. If you have not picked a health plan for your pregnancy, you may have already been placed into a health plan.
If you have questions about your managed care plan, call the Choice Counseling Helpline toll-free at, TDD: , Monday through Thursday, 8 a.m.-8 p.m. Friday, 8 a.m.-7 p.m.
Within Broad Federal And State Rules Plans Often Have Discretion In How To Ensure Access To Care For Enrollees And How To Pay Providers
To help ensure participation, many states require minimum provider rates in their contracts with MCOs that may be tied to fee-for-service rates. In a 2021 KFF annual survey of Medicaid directors, about two-thirds of responding states with MCO and/or limited benefit contracts reported a minimum fee schedule that sets a reimbursement floor for one or more specified provider types . Additionally, over half of responding states that contract with managed care plans reported a uniform dollar or percentage increase payment requirement in place as of July 2021, most commonly for hospitals. In response to the COVID-19 pandemic, states have options and flexibilities under existing managed care rules to direct/bolster payments to Medicaid providers and to preserve access to care for enrollees. More than one-third of responding MCO states implemented new provider payment and/or pass-through requirements on MCOs in response to the COVID-19 emergency in FY 2021.
Don’t Miss: Ohio Medicaid Assisted Living Facilities
A Number Of Large Health Insurance Companies Have A Significant Stake In The Medicaid Managed Care Market
States contracted with a total of 282 Medicaid MCOs as of July 2019. MCOs represent a mix of private for-profit, private non-profit, and government plans. As of July 2019, a total of 16 firms operated Medicaid MCOs in two or more states ,6 and these firms accounted for 63% of enrollment in 2019 . Of the 16 parent firms, seven are publicly traded, for-profit firms while the remaining nine are non-profit companies. Six firms UnitedHealth Group, Centene, Anthem, Molina, Aetna/CVS, and WellCare each have MCOs in 12 or more states and accounted for 51% of all Medicaid MCO enrollment . All six are publicly traded companies ranked in the Fortune 500.7 KFF analysis of more recent MCO enrollment data, from the subset of states that make these data available, showed that five for-profit parent firms accounted for almost 60% of the pandemic-related increase in MCO enrollment from March 2020 to March 2021 in these states. Earnings reports from Q4 2021 for these five for-profit parent firms showed year-over-year growth in Medicaid membership ranging from 10 to 20% and for the three firms that provided Medicaid-specific revenue information growth in Medicaid revenues ranging from 13 to 43%.8
How To Choose Your Pregnancy Care Plan
Once you are approved for Medicaid, you will be able to choose the right health plan for you and your baby.
The easiest way to do this is by calling the Choice Counseling Helpline toll-free at .A counselor will help you choose your care plan or switch to a plan provider.
For more information, visit this page on How to Enroll in a Medicaid Health Plan.
Recommended Reading: Therapeutic Boarding Schools That Accept Medicaid
Choosing The Right Health Plan For You
Choosing a health plan is a personal decision. While we are confident that all health plans are able to meet your needs, you may want to consider the following points when choosing a plan:
Provider Networks: Each health plan includes a group of health care providers . This is called a network of providers. For most health care services, you must use the health care providers who are in your health plan.
Primary or Specialty Medical Providers: When you are enrolled in a managed care program, you will choose a Primary Medical Provider, often called a PMP. Your PMP will work with you and be your primary contact when making medical decisions. Your doctor will also make referrals and help you with prior authorizations for services that are not always covered by Medicaid.
If you already have a doctor or other primary or specialty medical provider, when choosing your health plan, you will want to make sure that provider is part of the health plans network. If you do not have one, your health plan will work with you to identify one. To find out if your doctor or other primary medical provider is part of the health plans network, you should call the help line listed below.
Locations: You may want to make sure that the plan you choose has providers that are conveniently located for you. This may mean they are near your work or your childs school, or they may be on a bus line.
Read Also: Michigan Medicaid Waiver Assisted Living
Another Easy Way To Find Medicare Plans
As helpful as the Medicare.gov Plan Finder is, its not the only way to search for and compare Medicare plans in your area.
One alternative is to speak with a licensed insurance agent. An agent can discuss your health care needs and compile a list of available Medicare plans in your area.
Most importantly, an agent can help answer questions you are sure to have about costs, coverage, terms and conditions of plans and help you better understand exactly what it is you are shopping for.
Also Check: Medicaid Nursing Home Income Limits
Recommended Reading: Does Medicaid Cover Ambulance Services
Medicaid Coverage For Pregnancy Care
Community Care Plan offers health care with pregnancy coverage for Medicaid members in Broward County. Our Birth, Baby, and Beyond program helps women get the prenatal care and support that is so important for a healthy pregnancy.
If you are a Community Care Plan Medicaid member that is pregnant, please call us at .
5-Star Rated Pregnancy Care Four Years in a Row!
Community Care Plan is the only Medicaid health plan in the state of Florida to achieve 5 Stars in Pregnancy Care for four years in a row.*
American Disabilities Act Notice
In accordance with the requirements of the federal Americans with Disabilities Act of 1990 and Section 504 of the Rehabilitation Act of 1973 , UnitedHealthcare Insurance Company provides full and equal access to covered services and does not discriminate against qualified individuals with disabilities on the basis of disability in its services, programs, or activities.
Also Check: Inpatient Rehabs That Take Medicaid
Read Also: How Do I Get My Newborn On Medicaid
What Is Florida Medicaid Gold Card
Any provider can use your gold card or plans membership card to check the Florida Medicaid file to find out if you are eligible for Florida Medicaid services. Your gold card is a permanent identification. Even if your Florida Medicaid eligibility ends, you should always keep your gold card.
Additional Smmc Ltc Information:
For additional SMMC LTC information, including a program overview and summary, please visit AHCAs website at .
For information regarding the LTC plans available in each region and how to choose an LTC plan, please visit the Choice Counseling website at www.flmedicaidmanagedcare.com.
For more information regarding the SMMC LTC waitlist, please contact your local Aging and Disability Resource Center. Click here for the direct contact information of the ADRC in your region. You can also call the statewide Elder Helpline at 1-800-96-ELDER for immediate assistance.
For assistance in addressing a complaint with your LTC plan, please visit AHCAs website at and click on the Report a Complaint button.
Read Also: Ohio Medicaid Provider Exclusion Suspension List
When Can I Enroll In Medicare
Remember, you are automatically eligible to receive Medicare the day you turn 65. If you are already receiving Social Security benefits and enrolled in Medicare before you hit 65, you will automatically be enrolled in Part A of Medicare.
However, if you dont receive retirement benefits yet, elderly people can begin to enroll in Medicarebeyond Part Athree months before they turn 65, the month of your birthday, and three months after it. This seven-month period is called the Initial Enrollment Period. Applying for Medicare Advantage Plans and prescription plans occur during this period as well, and supplemental plans can be added at any time.
If you dont apply for Part B within this enrollment period, there can be late fees for enrolling at other times.
If you dont apply for Part B within this enrollment period, there can be late fees for enrolling at other times.
Just in case you miss the IEP, the General Enrollment Period for Medicare is between January 1 and March 31.
You can apply at a handful of places:
- Visit your local Social Security office
The process for enrolling in Part A takes less than 10 minutes, and adding on other plans wont take much longerespecially if youve done your research beforehand.
Recommended Reading: Can I Get A Breast Pump Through Medicaid
How To Apply For Medicaid In Florida
Knowing where and how to apply for Medicaid in Florida is important for residents who need medical benefits assistance. Petitioners must complete the FL Medicaid application form properly as well as submit the required documents. The Medicaid application and associated paperwork helps officials determine who is eligible for Medicaid coverage. Prospective applicants wondering where to apply for Medicaid in FL may be surprised about the methods and locations available for signing up for government assistance. To find out more about applying to Medicaid in Florida, continue reading the outlined information below.
Where do you sign up for Medicaid in Florida?
To find out where to apply for Medicaid, you first must look at all the options available in Florida. Applicants can apply for Medicaid online, by mail, in person or via fax. For those who have questions about Medicaid eligibility requirements, applying for Medicaid in person may be the best option, as there are representatives to assist with the process. Please be aware that enrollment in Medicaid is not lifelong. Recipients will have to reapply for Medicaid every 12 months or another predetermined time period.
Information Required on the Medicaid Application Form in Florida
The Florida Medicaid application form requires you to give a lot of details about yourself and your family. Regardless of how and where you apply to Medicaid, you will need to provide the following information:
Also Check: When Do You Apply For Medicaid
Types Of Marketplace Plans
Depending on how many plans are offered in your area, you may find plans of all or any of these types at each metal level Bronze, Silver, Gold, and Platinum.
Some examples of plan types youll find in the Marketplace:
-
Exclusive Provider Organization : A managed care plan where services are covered only if you use doctors, specialists, or hospitals in the plans network .
-
Health Maintenance Organization : A type of health insurance plan that usually limits coverage to care from doctors who work for or contract with the HMO. It generally won’t cover out-of-network care except in an emergency. An HMO may require you to live or work in its service area to be eligible for coverage. HMOs often provide integrated care and focus on prevention and wellness.
-
Point of Service : A type of plan where you pay less if you use doctors, hospitals, and other health care providers that belong to the plans network. POS plans require you to get a referral from your primary care doctor in order to see a specialist.
-
Preferred Provider Organization : A type of health plan where you pay less if you use providers in the plans network. You can use doctors, hospitals, and providers outside of the network without a referral for an additional cost.
Helping People Is At The Heart Of All We Do
Its your health, its your choice.
All Floridians deserve affordable health care, including you. We offer many plans to help Floridians get healthy and stay healthy. Our plans cover children, pregnant women, adults and people with disabilities.
Choose a plan that gives you more. UnitedHealthcare has a large provider network in Florida. That gives you more options to choose the right doctors and specialists for you and your family. We also offer more benefits and extras, which can make a real difference in your life.
Recommended Reading: Healthy Connections Medicaid Sc Phone Number
Each Year States Develop Mco Capitation Rates That Must Be Actuarially Sound And May Include Risk Mitigation Strategies
States pay Medicaid managed care organizations a set per member per month payment for the Medicaid services specified in their contracts. Under federal law, payments to Medicaid MCOs must be actuarially sound. Actuarial soundness means that the capitation rates are projected to provide for all reasonable, appropriate, and attainable costs that are required under the terms of the contract and for the operation of the managed care plan for the time period and the population covered under the terms of the contract. Unlike fee-for-service , capitation provides upfront fixed payments to plans for expected utilization of covered services, administrative costs, and profit. Plan rates are usually set for a 12-month rating period and must be reviewed and approved by CMS each year. States may use a variety of mechanisms to adjust plan risk, incentivize plan performance, and ensure payments are not too high or too low, including risk sharing arrangements, risk and acuity adjustments, medical loss ratios , or incentive and withhold arrangements.
Figure 2: CMS Has Provided Guidance to States to Address MCO Payment Issues in Response to the COVID-19 Pandemic.
Our Member Services Departmentcan Answer Your Questions
Community Care Plan members enrolled in our Medicaid plan can contact our team for help with many services.
If you are a Community Care Plan Medicaid member, please call us at for help with:
- Finding a provider
- Choosing or changing your Primary Care Provider
- Finding out if a service is covered
- Getting referrals
- Replacing a lost ID card
- Planning care for the birth of a new baby
- Explaining plan changes or benefit options
- Answering general plan questions
Community Care Plan values your care.If you have any concerns with your childrens Physical, Occupational or Speech Therapy Services, please call Yvie Noel at 622-3272.
Read Also: Does Colorado Medicaid Cover Lasik Eye Surgery
What Is The Role Of Area Agencies On Aging
The local AAAs provide education about the long-term care programs , screen individuals for the HCBS waiting list and assist with the completion of medical and financial eligibility.
Related Florida Medicaid Resources
If You Are Choosing A Health Plan For The First Time:
To keep your primary care provider , choose a health plan your PCP is in. Use these questions to help you choose the best health plan for you:
- Do you want to keep your current provider? Or do you want a new one?
- Does the health plan have the providers, hospitals and specialists you use? To find out, go to Find a provider.
- Does anyone in your family have special health needs?
- What added services does the health plan have? To view each health plans added services, go to View health plans.
Recommended Reading: Does Medicaid Cover Dental Bridges
Recommended Reading: How To Switch Providers On Medicaid
When Can I Enroll In A Medicare Plan Outside Of The Annual Enrollment Period
Outside of AEP, there are a few other opportunities to enroll or disenroll in a Medicare plan.
- Initial Enrollment Period : This is a window of time that starts three months before your 65th birthday and continues for three months after your birthday.
- Special Enrollment Period : Available when life changes or special circumstances occur outside of AEP that result in needing to change your current health plan. Learn more about SEP.
- Open Enrollment Period : Medicare eligible persons can make like plan changes from January 1 March 31. During this 3-month window, you can add or drop Part D coverage, or disenroll from a plan. Learn more about disenrolling.
Also Check: Does Medicare Cover Dental In Ny
