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.
Medicare is the federal health insurance program. You may qualify for Medicare if1:
See what medical and dental services your plan will cover.
|Benefit type||In-network coverage||What you need to know|
|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.|
|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 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.|
|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.|
|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.|
|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|
|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|
View benefits and coverage for other age groups.
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EOCCO members should have their member ID number ready for quicker help.See more options