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HealthChoice Frequently Asked Questions

Medicaid is a program for people with low income who meet certain eligibility requirements and programs can vary from state-to-state.

Medicare is a federal health insurance program for people who are age 65 or older, disabled persons, or those with end-stage kidney disease. Medicare eligibility is not based on income, and basic coverage is the same in each state.

When you apply for Medicaid, you must fill out an application form. You will also need to have various documents:

  • Household monthly income (including pay stubs, W-2 forms, or tax returns if you have them)
  • Social Security numbers or document numbers for each household member reapplying for coverage
  • Date of birth for each household member reapplying for coverage
  • Immigration information, if applicable
  • Additional information as requested

The Explanation of Benefits is a document you will get each month you use your prescription drug coverage. It will tell you the total amount you have spent on your prescription drugs and the total amount we have paid for your prescription drugs. You will get your Explanation of Benefits in the mail each month that you use the benefits that we provide.

A "medical emergency" is when you reasonably believe that your health is in serious danger – when every second counts. A medical emergency includes severe pain, a bad injury, a serious illness, or a medical condition that is quickly getting much worse.

If you have a medical emergency:

  • Get medical help as quickly as possible. Call 911 for help or go to the nearest emergency room, hospital, or urgent care center. You don’t need to get approval or a referral first from your primary care doctor or other plan provider.

If, while temporarily outside the Plan’s service area, you require urgently needed care, then you may get this care from any provider. The plan is obligated to cover all urgently needed care at the cost-sharing levels that apply to care received within the Plan network.

You must obtain covered services from network providers except in limited cases such as emergency care, urgent care, or when our network is not available. If you get non-emergency care from non-network providers without prior authorization, you must pay the entire cost yourself.

The Group ID may not appear on your member ID card.  For Maryland Medicaid members, your Group ID is MDCAID.  You may call 1-800-318-8821 (TTY: 711) for help with

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