EOCCO Benefits for members 64+

Benefits get better with age

Soon, you will turn 65. This means you may qualify for Medicare and other coverage, as well as your EOCCO plan. You may also transfer from Medicaid to Medicare.

Read on to learn more about Medicare and to see what your EOCCO plan covers. You may also qualify for premium payment assistance programs. Contact us to find out. We’re here to answer your questions.

We are here to guide you and answer any questions you may have about your health plan so you can get the care your child needs.

What is Medicare?

Medicare is the federal health insurance program. You may qualify for Medicare if1:

  • You are 65 or older
  • You are younger than 65 with certain disabilities
  • You have End-Stage Renal Disease (permanent kidney failure that requires dialysis or a transplant, sometimes called ESRD)

1 Find out if you qualify for Medicare.

What will your health plan cover?

See what medical and dental services your plan will cover.

Benefit type In-network coverage What you need to know
Medical
Primary care provider (PCP) Covered All EOCCO members have been assigned an in-network PCP or clinic.
Yearly checkups One visit per calendar year It is important to schedule a checkup every year. Your doctor will provide a physical exam and talk about important topics. Topics include healthy eating, exercise, preventive shots, safe sex, how to manage stress and more.
Women's annual exam Covered This is an annual exam and family planning visit.
Immunizations (shots) Covered You do not need a referral. You can get these from your doctor or any network provider.
Emergency room Covered An emergency is a condition that puts your life in danger. Call 911 or go to the emergency room when you think you are in danger.
Urgent care Covered This is care that you need the same day. You may need this kind of care for serious pain, an injury or illness, or to avoid losing function in part of your body. You do not need an appointment.
Specialist Covered You will need a referral from your PCP before seeing a specialist.
Hospital Covered You will need prior authorization (pre-approval) for hospital stays. Your doctor will get this approval. You do not need pre-approval for emergencies.
Labs, tests, X-rays Covered These are covered if your doctor orders them. Other authorized specialists may also order them.
Vision
Exam Limited coverage Members age 20 and younger can have an eye exam every 12 months. Pregnant woman 21 or older can have an eye exam every 24 months.
Glasses and contact lenses Limited coverage Members age 20 and younger can have new glasses or contacts lenses every 12 months. Pregnant woman 21 or older can have new glasses or contacts every 24 months.
Hearing
Hearing test Covered If you are needing hearing services, your doctor will make a referral.
Hearing aids Covered If you are needing hearing services, your doctor will make a referral.
Behavioral health
Provider visit and mental health assessments Covered You can ask for help with depression, anxiety or other mental health services. Services are confidential. No referral is needed when visiting an in-network provider.
Wraparound services Covered Services that bring together a team of community members and others needed to support parents, families and children.
Dental
Preventive care Covered This includes exams, cleanings, fluoride, varnish and X-rays.
Restorative care Covered This includes treatment for cavities and other problems such as fillings, tooth removal, crowns and dentures. It also includes root canals on back teeth for pregnant women and adults age 18-20.
Specialist care Covered You may need a referral to see a specialist. Please ask your dentist before you schedule a specialist appointment.
Orthodonia (braces) Not covered Braces are not covered unless you need them to treat cleft palate.
Urgent and immediate treatment Covered These are dental conditions that do not require emergency room care. Examples include toothache, swollen gums and lost fillings.
Emergency dental care Covered 24 hours, 7 days a week. In a dental emergency, call your dentist day or night.
Pharmacy
Prescription medications Covered These are medications that a PCP, specialist or other provider prescribes. You can get your prescriptions at any in-network pharmacy. A list of these pharmacies is in the provider directory.
Get more pharmacy-related information
Screenings
Mammogram (breast X-ray) Covered Preventive care
Prostate screening Covered Preventive care
Colorectal screening Covered Preventive care
Drug and alcohol screening Covered Behavioral health
Depression screening and follow-up plan Covered Behavioral health

 

Coverage by age

View benefits and coverage for other age groups.

Questions?

Customer Service: 888-788-9821 (TTY users: 711)
Hours: Monday through Friday, 7:30 a.m. to 5:30 p.m. PST

EOCCO members should have their member ID number ready for quicker help.

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