Medicare Coordinated Care Plans
 

Many Medicare beneficiaries find that coordinated care plans are a good way to get more health care for their dollar. Heart of America Health Plan will provide or arrange for all Medicare covered services. This means if you join a coordinated care plan and get all of your services through the Heart of America Health Plan, your out-of-pocket costs are usually more predicable. Also, depending on your health needs, those costs may be less than you would pay if you were liable for the regular Medicare deductibles and co-insurance amounts.

Advantages of Coordinated Prepaid Health Care
 

• No Medicare deductibles – only monthly premiums.

• No claim forms or other paperwork for you.

• Local administration.

• Predictable expenses – so you can easily budget your health care dollars.

• No health screening, waiting periods or pre-existing condition clauses.
   

Helping You Take Better Care of Yourself

Heart of America Health Plan contracts with the Centers for Medicare and Medicaid Service (CMS) of the U.S. Department of HHS as a Managed Care Cost Plan for Medicare. This enables HAHP to combine traditional Medicare benefits with its own coverage for individuals who are covered by Medicare Parts A & B or B only.
 

We Even Do the Paperwork

Your HAHP card is your identification for HAHP benefits. Present it at the doctor’s office, hospital or other health care facility and they’ll bill the HAHP directly. You don’t have to file claim forms or wait to be reimbursed for a bill you paid. If, by error, you do receive a bill, drop it in the mail t our office.
 

When You Go to the Hospital, Heart of America Health Plan is There

HAHP provides for the catastrophic as well as the routine events. You’re covered in the hospital under Medicare limitations – up to 150 days per Medicare benefit period. We want you to seek care as soon as you need it. Preventive health measures are the key to the Managed Care concept.

Joining HAHP means that you get prompt, personal service when you have a question or problem. If you’re not satisfied with the decision of the HAHP staff or medical care that you have received, you may appeal it through the HAHP Grievance Procedure and Medicare Appeals Procedure. The Grievance Procedure and Medicare Appeals Procedure is available to all HAHP members who request to file a formal complaint report.
 

Ready With Care When and Where You Need It

The HAHP is a non-profit health plan for residents of the defined HAHP service area. You must reside within the following specified zip code area:

58310 58324 58342 58357 58367 58423 58713 58748
58313 58325 58343 58359 58368 58438 58717 58762
58316 58329 58346 58360 58369 58450 58736 58783
58317 58331 58348 58362 58374 58451 58739 58788
58318 58332 58351 58363 58384 58465 58741 58789
58319 58337 58353 58365 58385 58710 58744 58793
58320 58341 58356 58366 58386 58712 58747
 

HAHP works through cooperative agreements between you, the, member, and the doctors and hospitals in this area. These agreements allow the HAHP to best manage your health care dollar – and you health.

Participating physicians agree to accept a fee from HAHP as payment in full for their services, to participate in incentives to control costs, and to allow review of their care by other physicians according to standards of practice in this community.

Members agree t receive all of their primary care through one of the HAHP Plan Physicians, and to obtain a referral for specialty care. Your HAHP Plan Physician is responsible for providing your routine care and referring you to other doctors when necessary.

There are also some specialized services not available through HAHP Plan Physicians, so you may be referred to a larger medical center by your Plan Physician with prior approval by HAHP’s Medical Director.

HAHP/Medicare covers this type of care for you, too!
 

Who Is Eligible To Join?

To be eligible for membership in HAHP you must be entitled to Benefits under Medicare Parts A & B or Part B only. You must reside within the specified HAHP service area. You must not be receiving any Hospice Care of currently have end-stage renal disease. There may be exceptions to these requirements. Please contact our office if you have any questions.
 

Enrolling In HAHP

The Heart of America Health Plan coordinates its benefits with traditional Medicare coverage. As a member of the HAHP, you must receive all of your primary medical care through one of the HAHP’s Plan Physicians except in the case of an emergency or urgent care out of the service area.

To enroll, simply complete an application form available at the HAHP office. Once enrolled, your HAHP Plan Physician will make arrangements for specialized care or hospitalization. The HAHP will not coordinate your Medicare coverage unless your medical services are performed, prescribed, arranged or authorized by your HAHP Plan Physician.

Enrollment in Heart of America Health Plan will result in automatic disenrollment from any Managed Care Cost Plan you may be enrolled in as you cannot be a member of two Medicare-contracting Managed Care Cost Plans at the same time.
 

Disenrolling From HAHP

1. You may voluntarily desenroll from HAHP at any time by giving written notice to the HAHP office or by contacting your local Social Security Office. If you have Railroad Retirement Benefits, you can call your local Railroad Retirement Board office at 1-800-808-0772. You can also call 1-800-MEDICARE (1-800-633-4227). Disenrollment becomes effective the first month following the month your written notice is received.


2. You will never be disenrolled from the HAHP due to a health
condition. The HAHP may disenroll a member under the following condition:

* Failure to pay a premium when necessary

The HAHP must disenroll a member under the following conditions:

* Moving out of the HAHP Service Area
* Death
* Loss of Medicare Part B
* Committing fraud or abuse of membership

 

What About Emergencies and Out of Area Urgent Care?

Your HAHP Plan Physician will manage all of your routine care, office calls, diagnostic and other preventive health care. However, there will be times when you are unable to schedule an appointment, such as in the case of an emergency or urgently needed services while you are away from home. A medical emergency is a sudden, severe, and unforeseen onset of illness or injury requiring immediate medical attention. Urgent care is care for an unforeseen illness or injury which a member which a member requires in order to prevent a serious deterioration in their health while out of the HAHP service area. I a member has a medical emergency or requires urgent care outside the service area, they are asked to obtain prompt medical attention and to notify the HAHP office as soon as medically possible.
 

Specialist Care

Members of the Heart of America Health Plan agree to receive their primary care from on of the Plan Physicians of the Johnson Clinic. Plan Physicians will provide for, arrange and coordinate a member's health care needs, including, when necessary, referrals, to specialists to meet individual needs.

If an HAHP member is to have specialty care performed by a Non-Plan Physician or care at a Specialty Facility, they must receive a referral from their Plan Physician prior to receiving the specialty care.
 

If You Go Out of the Plan

If a member consults a Non-Plan Physician or care at a Specialty Facility without prior approval from the Plan, the member's claim must be submitted to Medicare, and the member is responsible for the cost of services not paid by Medicare, 20% coinsurance and any non-covered charges in excess of Medicare approved amounts. In other words, you will not be provided the added benefits of the HAHP for care from a Non-Plan Physician or Specialty Facility that is not approved by the Plan in advance of care received. BENEFITS