Frequently Asked Questions
Medicare and Medicare Advantage are very comprehensive and excellent programs. In an ever changing world, we want to provide you with an avenue of information driven by you our member.
Please let us know what you would like us to cover in this section. Please write to us at caresource@mrchp.com and we will post your question right here along with the following.
General
How can I compare my options?
You can compare Mid Rogue Health Plan and the Original Medicare Plan using the Summary of Benefits download. The charts list some important health benefits. For each benefit, you can see what our plan covers and what the Original Medicare Plan covers.
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Where is Mid Rogue Health Plan available?
The service area for this plan includes: Douglas*, Jackson*, Josephine and Curry counties, OR. You must live in one of these places to join the plan.
*Please see Section Three of the Summary of Benefits download for a detailed description of our service area.
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Can I choose my doctors?
CareSource has formed a Network of doctors, specialists and hospitals. You can only use doctors that are part of our Network except for our Diamond plans and the Platinum plan Point-Of-Service option. The health providers in our Network can change at any time. You can ask for, or download a current Provider Directory for an up-to-date list. Our number is listed below as well as an E-mail address where you can request one electronically. Please provide a valid street address when requesting by E-mail.
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What happens if I go to a doctor who is not in your network?
If you choose to go to a doctor outside our network, you must pay for these services yourself except for our Diamond plans and the Platinum plan Point-Of-Service option. Neither CareSource nor the Original Medicare Plan will pay for these services. Also in addition to emergent and urgent care, there may be circumstances when your primary care physician or your specialty care physician will refer you to non-Network providers. Prior authorization is needed and co-payments, if any, apply. More information can be found in the Summary of Benefits download.
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What types of drugs are covered under Medicare Part B?
The following outpatient prescription drugs may be covered under Medicare Part B. This may include, but not limited to, the following types of drugs:
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Some Antigens: If they are prepared by a doctor and administered by a properly instructed person (who could be the patient) under doctor supervision.
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Osteoporosis Drugs: Injectable drugs for osteoporosis for certain women with Medicare.
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Erythropoietin: (Epoetin alpha or Epogen®) By injection if you have end stage renal disease (permanent kidney failure requiring either dialysis or transplantation) and need this drug to treat anemia.
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Hemophilia Clotting Factors: Self-administered clotting factors if you have hemophilia.
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Injectable Drugs: Most injectable drugs administred incident to a physician's service.
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Immunosuppressive Drugs: Immunosuppressive drug therapy for transplant patients if the transplant was paid for by Medicare, or paid by a private insurance that paid as a primary payer to your Medicare Part A coverage, in a Medicare-certified facility.
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Some Oral Cancer Drugs: If the same drug is available in injectable form.
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Oral Anti-Nausea Drugs: If you're part of an anti-cancer chemotheraputic regimen.
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Inhalation and infusion drugs provided through DME.
Contact CareSource for more details
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Part D
What is a Medication Therapy Management (MTM) Program?
A Medication Therapy Management (MTM) Program is a benefit that your plan may offer. You may be identified to participate in a program designed for your specific health and pharmacy needs. It is recommended that you take full advantage of this covered benefit if you are selected. Contact CareSource for more details.
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Does my plan have a Prescription Drug Formulary?
CareSource uses a formulary. A formulary is a list of drugs selected to meet patient needs. The plan may periodically make changes to the formulary. If the formulary changes, affected enrollees will be notified, in writing, before the change is made.
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Where can I get my prescriptions if I join this plan?
CareSource has formed a network of pharmacies. You can use any pharmacy in our network. The pharmacies in our network can change at any time. You can ask for a current Pharmacy Network List. Contact CareSource for more details.
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What happens if I go to a pharmacy that's not in your network?
If you go to a pharmacy that's not in our network you might have to pay more for your prescription to be covered under our plan. For more information, contact CareSource.
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Does my plan cover Medicare Part B or Part D drugs?
Original CareSource does cover Medicare Part B prescription drugs. CareSource Plus Rx covers both Medicare Part B prescription drugs and Part D prescription drugs.
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What types of drugs are covered under Medicare Part B?
The following outpatient prescription drugs may be covered under Medicare Part B. This may include, but not limited to, the following types of drugs:
-
Some Antigens: If they are prepared by a doctor and administered by a properly instructed person (who could be the patient) under doctor supervision.
-
Osteoporosis Drugs: Injectable drugs for osteoporosis for certain women with Medicare.
-
Erythropoietin (Epoetin alpha or Epogen® ): By injection if you have end stage renal disease (permanent kidney failure requiring either dialysis or transplantation) and need this drug to treat anemia.
-
Hemophilia Clotting Factors: Self-administered clotting factors if you have hemophilia.
-
Injectable Drugs: Most injectable drugs administred incident to a physician's service.
-
Immunosuppressive Drugs: Immunosuppressive drug therapy for transplant patients if the transplant was paid for by Medicare, or paid by a private insurance that paid as a primary payer to your Medicare Part A coverage, in a Medicare-certified facility.
-
Some Oral Cancer Drugs: If the same drug is available in injectable form.
-
Oral Anti-Nausea Drugs: If you're part of an anti-cancer chemotheraputic regimen.
-
Inhalation and infusion drugs provided through DME.
Contact CareSource for more details
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Special Needs Plan (SNP)
How Can I Compare My Options?
You can compare CareSource-SNP and the Original Medicare Plan using the Summary of Benefits download. The charts list some important health benefits. For each benefit, you can see what our plan covers and what the Original Medicare Plan covers. Our members receive all of the benefits that the Original Medicare Plan offers. We also offer additional benefits, which may change from year to year.
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Where Is CareSource-SNP Available?
The service area for this plan includes: Douglas*, Jackson*, Josephine and Curry counties, OR. You must live in one of these places to join the plan.
(Note: '*' denotes partial counties)
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Can I Choose My Doctors?
CareSource-SNP has formed a network of doctors, specialists and hospitals. You can only use doctors who are part of our network. The health providers in our network can change
at any time. You can ask for a current Provider Directory for an up-to-date list. Our number is listed below as well as an E-mail address where you can request one electronically. Please provide a valid street address when requesting by E-mail
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Does My Plan Cover Medicare Part B Or Part D Drugs?
CareSource-SNP does cover Medicare Part B prescription drugs and Part D prescription drugs
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Does My Plan Have A Prescription Drug Formulary?
CareSource-SNP uses a formulary. A formulary is a list of drugs selected to meet patient needs. The plan may periodically make changes to the formulary. If the formulary changes, affected enrollees will be notified, in writing, before the change is made. Contact
CareSource-SNP for more details.
Back to top
What Types Of Drugs May Be Covered Under Medicare Part B?
The following outpatient prescription drugs may be covered under Medicare Part B. This may include, but is not limited to, the following types of drugs:
-
Some Antigens: If they are prepared by a doctor and administered by a properly instructed person (who could be the patient) under doctor supervision.
-
Osteoporosis Drugs: Injectable drugs for osteoporosis for certain women with Medicare.
-
Erythropoietin (Epoetin alpha or Epogen®): By injection if you have end-stage renal disease (permanent kidney failure requiring either dialysis or transplantation) and need this drug to treat anemia.
-
Hemophilia Clotting Factors: Self-administered clotting factors if you have hemophilia.
-
Injectable Drugs: Most injectable drugs administered incident to a physician’s service.
-
Immunosuppressive Drugs: Immunosuppresive drug therapy for transplant patients if the transplant was paid for by Medicare, or paid by a private insurance that paid as a primary payer to your Medicare Part A coverage, in a Medicare-certifi ed facility.
-
Some Oral Cancer Drugs: If the same drug is available in injectable from.
-
Oral Anti-Nausea Drugs: If you’re part of an anti-cancer chemotherapeutic regimen.
-
Inhalation and infusion drugs provided through DME.
Contact CareSource-SNP
for more details.
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