Beneficiaries who are enrolled in Medicare Parts A and B and are certified as eligible for Medicaid qualify for Medicare Platino’s benefits and services.
If you meet the following requirements:
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65 years of age or older.
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Be an eligible beneficiary for Medicaid coverage (Department of Health’s Medicaid Office) and a Plan Vital participant.
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Citizen of the U.S. or legal resident of the United States.
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Live in the Medicare Advantage plan’s area of service
Additional Information
- When a beneficiary is referred to a specialist by his/her primary care physician (PCP) and the specialist prescribes medications, the PCP’s endorsement / signature will not be required on the prescription.
- In those cases where the MAO (Medicare Advantage Organization) contracts primary medical groups (PMGs) who, in turn, have a preferred network of specialists directly contracted by the PMGs, it will not be necessary to obtain a referral from the PCP when both parties are a part of the same PMG. Nonetheless, the specialist is required to report to the PCP about the medical services rendered.
- Beneficiaries may visit Gynecology/Obstetrics and Urology specialists without the need of a referral from the PCP.
- A referral will not be required for services related to pathology laboratories.
- Every MAO must send the monthly Explanation of Benefits (EOB) notification, including a summary of its referral procedure to all Medicare Platino beneficiaries to ensure that the beneficiaries are informed.
- Every MAO should inform and train all its primary care providers about its referral procedure and ensure that these providers understand the process to guarantee their coordination of health care services with the specialists.
- Bioequivalent drugs are mandatory.
- Beneficiaries aged 60 years or older may select a geriatrician as their PCP.