New for 2023 - Hillcrest HealthCare System is in network for Senior Health Plan.

Frequently Asked Questions

Get answers to some of the most frequently asked questions regarding CommunityCare Options.

What is CommunityCare Options (PPO)?

CommunityCare Options is a Medicare Advantage Plan ā€“ also knows as Part C. Medicare Advantage Plans combine the benefits of Original Medicare A & B and include benefits not covered by Original Medicare such as dental, vision and prescription drug coverage. CommunityCare Options is contracted with Medicare to administer your benefits ā€“ in other words, we pay your claims.

What are my benefits if Iā€™m traveling?

You have worldwide coverage for urgent & emergency care.

Do I lose my Medicare when I join?

No. You must be enrolled in Medicare A & B and continue to pay your Part B premium in order to enroll in a Medicare Advantage plan. However, while you are a member of CommunityCare Options, you will show your CommunityCare Options ID card when you receive services. Your provider may request to see your Medicare card to update their information, but CommunityCare Options is paying your claims.

When can I enroll in CommunityCare Options?

The earliest you can enroll is when your Medicare A and B are effective. You can submit an application up to three months before your Medicare A & B begins, and as late as three months after your Medicare A & B effective date. Once you enroll in a plan, you are generally "locked into" that plan for the calendar year and can change plans during the Annual Election Period (AEP).

The Annual Election Period begins October 15th and ends December 7th of each year. There are also circumstances during the year when you might be able to enroll. If you have moved into the service area and this is a new option for you, you have a special election period. There are also special election periods for people who have Medicaid, Extra Help or Low-Income Subsidy, or for those in nursing homes. If you want to know if you qualify for a Special Election Period, call our Medicare team at 918-594-5275.

For more information read the ABC's (and D) of Medicare.

Do I choose my own doctor?

Yes. This plan is a PPO, so you have the option to see providers that are not in our network. Keep in mind though that you will generally pay 30% of the cost when using out of network providers.

Search our provider directory.

What do I do in an emergency?

CommunityCare Options provides worldwide coverage for medical emergencies. If you find yourself in an emergency, whether inside or outside CommunityCare Options's service area, go to the nearest doctor or hospital or call 911. Your safety is what counts!

We ask that you notify your doctor within 48 hours or as soon as reasonably possible to arrange follow-up care.

What constitutes an emergency or urgent need for care?

Emergency medical condition means a medical condition manifesting itself by acute symptoms of sufficient severity (including severe pain) such that a prudent layperson, with an average knowledge of health and medicine, could reasonably expect the absence of immediate medical attention to result in:

  • serious jeopardy to the health of the individual or, in the case of a pregnant woman, the health of the woman or her unborn child;
  • serious impairment to bodily functions; or
  • serious dysfunction of any bodily organ or part.

Emergency services means covered inpatient and outpatient services that are:
  • furnished by a provider qualified to furnish emergency services; or
  • needed to evaluate or stabilize an emergency medical condition.

These services are considered to be emergency services, and continue to be emergency services, as long as transfer to a CommunityCare Options participating provider would be a risk to your health, or because transfer would be unreasonable, given the distance involved in the transfer and/or the nature of your medical condition.

Urgently needed services means covered services provided when an enrollee is temporarily absent from CommunityCare Options's service area (or, under unusual and extraordinary circumstances, provided when the enrollee is in the service area but CommunityCare Options's provider network is temporarily unavailable or inaccessible) when such services are medically necessary and immediately required:
  • as a result of an unforeseen illness, injury, or condition; or
  • it was not reasonable given the circumstances to obtain the services through CommunityCare Options.

If an urgent medical need arises, seek care from a local doctor. Should this prove to be difficult, you may seek care from a hospital emergency room. Follow-up care is expected to be provided by your CommunityCare Options primary care physician.

What about pharmacy benefits?

CommunityCare Options Gold includes Medicare Part D prescription drug coverage. Call us for more information, or you may also refer to the Summary of Benefits - 05/11/2023 or Evidence of Coverage - 04/17/2023.

You can also visit the Pharmacy and Prescription Info page for more information.

What are my disenrollment rights and responsibilities?

You may end your membership in our plan only during certain times of the year, known as enrollment periods. All members have the opportunity to leave the plan during the Annual Enrollment Period and during the Medicare Advantage Open Enrollment Period. In certain situations, you may also be eligible to leave the plan at other times of the year. Until your membership ends, you must keep getting your medical services and drugs through our plan. Chapter 10 of the 2023 Evidence of Coverage provides information about ending your membership. More information regarding Disenrollment.

Do you have questions about Medicare?

If you are new to Medicare and have questions, visit our ABC's of Medicare page.