Ozark Health Plan is provided by Arcadian Health Plan, Inc., a Coordinated Care Plan with a Medicare Advantage contract. Anyone with Medicare Parts A and B, and residing in the service area of the plan, may apply. Dual Plus Plan only: The plan is available to anyone who has both Medical Assistance from the state and Medicare. Premiums, co-pays, co-insurance and deductibles may vary based on the level of help received.You must continue to pay your Medicare Part B premium if not otherwise paid for under Medicaid or by another third party. You must use plan providers except in emergent or urgent care situations or for out-of-area renal dialysis. If you obtain routine care from out-of-network providers neither Medicare nor Arcadian Health Plan, Inc. will be responsible for the costs. Limitations, monthly premiums, copayments and coinsurance will apply.
In general, beneficiaries must use network pharmacies to access their prescription drug benefit, except in non-routine circumstances, and quantity limitations and restrictions may apply.
You may be able to get extra help to pay for your prescription drug premiums and costs. To see if you qualify for getting extra help, call: 1-800-MEDICARE (1-800-633-4227), TTY/TDD users should call 1-877-486-2048, 24 hours a day/7 days a week; the Social Security Administration at 1-800-772-1213, TTY/TDD users should call 1-800-325-0778, Monday - Friday, 7:00 a.m. - 7:00 p.m.; or your State Medicaid Office.
People with limited incomes may qualify for extra help to pay for their prescription drug costs. If eligible, Medicare could pay up to one-hundred (100) percent of drug costs including monthly prescription drug premiums, annual deductibles, and coinsurance. Additionally, those who qualify will not be subject to the coverage gap or late enrollment penalty. Many people are eligible for these savings and don´t even know it. For more information about this Extra Help, contact your local Social Security office or call 1-800-MEDICARE (1-800-633-4227), 24 hours per day, 7 days per week. TTY users should call 1-877-486-2048.
With Ozark Health Plan. Your health care will be coordinated by you and your Primary Care Physician (PCP). If needed, your PCP will make a referral to a specialist or medical care providers who will help determine the best methods and treatments for your health care needs. Generally, you may only enroll in this plan during a certain time of the year. Please contact 1-800-653-2924 (TTY/TDD 1-866-573-8613), Sunday - Saturday, 8:00 a.m. - 8:00 p.m. for more information. Medicare beneficiaries may enroll in Ozark Health Plan through the Centers for Medicare & Medicaid Services Online Enrollment Center, located at www.medicare.gov . For more information contact the Ozark Health Plan at 1-866-237-8751 (TTY/TDD 1-866-573-8613)
The plan is authorized by law to refuse to renew its contract with CMS, that CMS also may refuse to renew the contract, and that termination or non-renewal may result in termination of the beneficiary´s enrollment in the plan. In addition, the plan may reduce its service area and no longer offer services in the area where the beneficiary resides.
Ozark Health Plan pharmacies include retail, mail order, and long term care. Mail order prescription drugs are available for up to a 90-day supply. All formulary drugs may be obtained through the mail order service.
Members have a right to appeal any decision the organization or plan makes regarding, but not limited to, a denial, termination, or reduction of services or benefits. This includes denial of payment for a service after the service has been rendered (post-service) or denial of service prior to the service being rendered (pre-service). Members may refer to the Evidence of Coverage for more information.
This information may be available in a different format. Please call Member Services at the number listed below if you need plan information in another format or language.
Members may enroll only during certain times of the year.
For full information on Ozark Health Plan, please call our Customer Service Department at 1-800-573-8597. Office hours are Mon-Sun 8 a.m. to 8 p.m., TTY/TDD: 1-866-573-8591.
Benefits, formulary, pharmacy network, premium and/or co-payments/co-insurance may change on January 1, 2012.