Frequently Asked Questions

Use the links below to get answers to some of the most frequently asked questions regarding Senior Health Plans or click here for our helpful video series.


What is CommunityCare Senior Health Plan?

CommunityCare Senior Health Plan was created especially for people on Medicare. CommunityCare has contracted with the federal government to operate Senior Health Plan. There are four Medicare Advantage Plans to fit the varying needs of Medicare beneficiaries.

  • Senior Health Plan Silver Plus
    Medical with Part D Coverage with no monthly premium and low hospital and physician copay
  • Senior Health Plan Platinum
    Medical with Part D Coverage with a $42 per month monthly premium and low hospital and physician copay
  • Senior Health Plan Platinum Plus
    Medical with Part D Coverage with a $110 per month monthly premium and low hospital and physician copay
  • Senior Health Plan Silver
    Medical only with no monthly premium and low hospital and physician copay

How does Senior Health Plan operate in the Medicare system?

CommunityCare has a contract with the Federal government to provide Medicare services. Under this contract, the government pays us a fixed monthly amount of money for each Medicare member we serve. CommunityCare handles virtually all paperwork and medical services for our members.

Do I lose my Medicare when I join?

No. You must be enrolled in both Medicare Parts A & B in order to be enrolled in our plan. However, while you are a member of Senior Health Plan you will only show your CommunityCare ID card. Keep your red, white, and blue Medicare card in a safe place in case you need it later.

Do I choose my own doctor?

Yes. You choose your own primary care physician from a long list of physicians affiliated 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.

Can I change doctors?

Yes. You may change doctors for any reason, as long as the new doctor you select is a CommunityCare Senior Health Plan provider. Simply call Member Services and we will help you select another doctor.

What do I do in an emergency?

CommunityCare Senior Health Plan gives you 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 $75 is required for emergency treatment, but is waived upon admission to a hospital.

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 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.

What about pharmacy benefits?

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 us at (918) 594-5323 for more information about our plans or you may also refer to the Summary of Benefits 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.

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 annual Medicare Advantage Disenrollment Period. In certain situations, you may also be eligible to leave the plan at other times of the year. Chapter 10 of the 2017 Evidence of Coverage provides information about ending your membership. Click here for more information regarding Disenrollment.

Disclaimers

  • You may join or leave a plan only at certain times. Please call Senior Health Plan at the telephone number listed in the previous section of this web page or 1-800-MEDICARE (1-800-633-4227) for more information. TTY users should call 1-877-486-2048. You can call this number 24 hours a day, seven days a week.
  • You can join Senior Health Plan if you are entitled to Medicare Part A and enrolled in Medicare Part B and live in the service area. However, individuals with End Stage Renal Disease are generally not eligible to enroll in Senior Health Plan unless they are members of our organization and have been since their dialysis began.
  • Senior Health Plan 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 or search the Senior Health Plan provider directory on this website. If you choose to go to a doctor outside of our network, you must pay for these services yourself. Neither Senior Health Plan nor Original Medicare will pay for these services.
  • You must continue to pay your Medicare Part B premium, even if the Senior Health Plan premium is $0.