Senior Health Plan is a Medicare Advantage Plan – 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. Senior Health Plan is contracted with Medicare to administer your benefits – in other words, we pay your claims.

HMO stands for Health Maintenance Organization. This means you have a network of contracted providers to choose from. Generally, on an HMO, if you choose to see a doctor that is not contracted with Senior Health Plan, you will be responsible for paying the provider. That said – our members have access to a broad network of providers that include Ascension St. John, Hillcrest, OSU Medical and Saint Francis (other providers are available in our network). In fact, Senior Health Plan is the only Medicare Advantage plan contracted with all four of these premier health systems.

The good news is, when you are a member of Senior Health Plan you take us with you. Senior Health Plan includes worldwide emergency and urgent care benefits. This gives you peace of mind when you are away. If you are experiencing a medical emergency, you can go to the nearest emergency room and your copay will be the same as if you were at your home hospital. If you are outside the service area and need to visit an urgent care, your copay is the same as if you were here. We recommend you let your PCP know if you received care, so any continued care can be coordinated with your in-network doctors.

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 Senior Health Plan, you will show your CommunityCare ID card when you receive services. Your provider may request to see your Medicare card to update their information, but CommunityCare is paying your claims.

There are different enrollment periods for Medicare and Medicare Advantage Plans. 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.

Yes. You choose your own primary care physician from a long list of physicians contracted with Senior Health Plan. You may choose any primary care physician (PCP) you wish, but we recommend that you select one close to home. This will give you the chance to build a stronger doctor-patient relationship.

Search our provider directory.

Yes. You may change your primary care doctor for any reason, as long as the new doctor is contracted with the plan as a Primary Care Physician. Call our Customer Service team to change your provider. And even though our plan is an HMO, we don’t require you to get a referral to see an in-network specialist. Be sure to check our online provider directory for the most up to date information

Senior Health Plan provides worldwide coverage for medical emergencies. If you find yourself in an emergency, whether inside or outside Senior Health Plan'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.

A copayment of $90 is required for emergency treatment, but is waived if you are admitted as an inpatient within 48 hours. Please refer to the Evidence of Coverage (EOC) for details about Emergency 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 Senior Health Plan 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 Senior Health Plan's service area (or, under unusual and extraordinary circumstances, provided when the enrollee is in the service area but Senior Health Plan'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 Senior Health Plan.

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 Senior Health Plan primary care physician.

Three of our plans are Medicare Advantage Prescription Drug (MAPD) plans and include Medicare Part D prescription drug coverage –Silver Plus, Platinum and Platinum Plus. Our Silver plan is Medical only coverage and does not include Part D. Call our Sales & Enrollment team at (918) 594-5275 for more information about our plans or you may also refer to the Summary of Benefits - Silver Plus, Platinum, Platinum Plus for more information about our Senior Health Plan options.

Keep in mind that if you enroll in our Silver Plan (Medical Only), you cannot enroll in a Part D plan with another company. Also, if you don't have Medicare prescription drug coverage or creditable coverage (meaning prescription drug coverage that is as good as Medicare's), you may have to pay a late enrollment penalty if you enroll in Medicare prescription drug coverage in the future.

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

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 2024 Evidence of Coverage provides information about ending your membership. More information regarding Disenrollment

If you are new to Medicare and have questions, visit our ABC's of Medicare page, or call our Medicare team at (918) 594-5275 (TTY/TDD users should call 1-800-722-0353), Monday through Friday from 8:00 am to 6:00 pm.