INTRODUCING KyHealth Choices A New Beginning For Kentucky Medicaid
2 KyHealth Choices KyHealth Choices is the new name for Kentucky Medicaid. It represents a much improved Medicaid program. What is KyHealth Choices ?
3 KyHealth Choices Why is Kentucky making changes to the Medicaid program? What’s wrong with the current program?
4 KyHealth Choices Kentucky Medicaid has limited resources. However, we want to continue to serve the people of Kentucky in the most effective manner possible. KyHealth Choices is the way to do that.
5 KyHealth Choices KyHealth Choices will stretch state resources to better meet your health care needs and will help you be more involved in your own health care.
6 KyHealth Choices Is everyone who has a Medicaid card in KyHealth Choices? No. If you are currently being served by Passport, then KyHealth Choices does not affect you. If you need more information regarding Passport, please call (800) 585-7900.
7 KyHealth Choices All other Medicaid members will be served under KyHealth Choices.
8 KyHealth Choices What Does KyHealth Choices Mean To You?
9 KyHealth Choices As a member of KyHealth Choices you will be assigned to one of four health plans.
11 KyHealth Choices Family Choices will cover most children including the KCHIP children. Optimum Choices covers individuals with mental retardation and developmental disabilities in need of long-term care.
12 KyHealth Choices Comprehensive Choices covers individuals who are elderly and in need of a nursing facility level of care and also individuals with acquired brain injuries. Global Choices will cover everyone not included in another plan.
13 KyHealth Choices What if I am currently in a waiver program? You will not lose services or eligibility when you are moved from the old waivers to the new waiver. Individuals being served in the Home and Community Based (HCB), Model II and Acquired Brain Injury (ABI) Waivers will be moved to Comprehensive Choices. Individuals being served in the Supports for Community Living (SCL) Waiver will be moved to Optimum Choices.
14 KyHealth Choices Do I need to do anything? No, Medicaid will automatically assign you to a plan. You don’t need to do anything.
15 KyHealth Choices Will I receive a new card? No, you will use your current card. Your health plan will be mailed to you when KyHealth Choices begins.
16 KyHealth Choices Will I lose services? No, but the amount of some services you receive may be limited. You will not be denied health care services that are necessary.
17 KyHealth Choices What if I get really sick and I need more services? No need to worry. Y our doctor or health care provider can request that the limit be expanded for you. KyHealth Choices will cover all the services that are necessary to ensure your good health.
18 KyHealth Choices Are there limits on prescription medicines in KyHealth Choices ? Yes, prescription medicines are limited to a total of four per month.
19 KyHealth Choices But I take more than four prescriptions. That’s OK. If your doctor is prescribing more than four medications and they are all medically necessary, then they will be covered.
20 KyHealth Choices I have a chronic disease. Are the prescription limits the same for me? KyHealth Choices recognizes that individuals with chronic diseases have great medical needs. Therefore, some chronic diseases are exempt from prescription limitations.
21 KyHealth Choices I am on both Medicare and Medicaid. What about my prescription medications?
22 KyHealth Choices If you receive both Medicaid and Medicare Part D, you need to be aware of big changes to your plan. IMPORTANT NOTICE:
23 KyHealth Choices Medicaid and Medicare are not the same. KyHealth Choices is Medicaid and not Medicare. Medicare is run by the federal government. Medicaid is operated by the state.
24 KyHealth Choices Effective January 1, 2006, Medicare now covers your medications based on its own health care plan. Medicaid no longer covers those medications.
25 KyHealth Choices Will I have to pay anything for services and prescriptions covered under KyHealth Choices ? Yes. Under KyHealth Choices you will have to pay a co-pay for some services and prescriptions.
26 KyHealth Choices What’s a co-pay? A co-pay is a small portion of the actual cost of the service or prescription. You will pay a co-pay when you get your health care service or pick up your prescription.
27 KyHealth Choices How much will I have to pay? In most instances co-pays will average $1 to $10 per service or prescription. There are no co-pays for some services.
28 KyHealth Choices What’s the total I will have to pay for the year? The maximum out-of-pocket expense you will have to pay is $225 for health care services and $225 for prescriptions, per year. All co-pays you make count toward the maximum amounts.
29 KyHealth Choices How do I know which service has a co-pay? KyHealth Choices will send you a list of services and co-pays when the program starts in mid-2006.
30 KyHealth Choices If I take good care of myself, does that make a difference? Yes. KyHealth Choices wants to keep you from getting sick. For that reason, there are no co- pays for preventive services, like annual check-ups.
31 KyHealth Choices Get Healthy Accounts If you have asthma, diabetes or heart disease, KyHealth Choices will offer “Get Healthy Accounts.” Get Healthy Accounts will allow you to earn rewards for such things as keeping appointments or filling medications in a timely manner.
32 KyHealth Choices Get Healthy Accounts Get Healthy Account rewards can be used to pay for smoking cessation programs, weight loss programs, gym memberships or to pay your co-pays.