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Frequently Asked Questions
Keystone 65 Complete
1. Who can join Keystone 65 Complete?
2. How much does Keystone 65 Complete cost?
3. I already have Medicaid and Original Medicare. Why join Keystone 65 Complete?
4. Do I have to pick a Primary Care Physician?
5. Which doctors can I see?
6. Do I need a referral to see a specialist?
7. If I don’t join Keystone 65 Complete, will Medicaid still pay for my prescriptions?
8. The government picked my drug plan for me. Can I switch to Keystone 65 Complete?
9. What programs does Keystone 65 Complete offer to help keep me healthy?
10. Do I have to send in my bills or claim forms?
11. Do I qualify for low-income subsidy?
12. How can I get more information?
top of page1. Who can join Keystone 65 Complete?
You must be entitled to Medicare Part A and enrolled in Medicare Part B, and you must be enrolled in a Medicaid program, such as Healthy Horizons. You must live in Bucks,
2. How much does Keystone 65 Complete cost?
If you are eligible to join, Keystone 65 Complete has a $0 monthly premium. You may have an additional copay for prescription drugs.
3. I already have Medicaid and Original Medicare. Why join Keystone 65 Complete?
With Keystone 65 Complete, you’ll get more benefits and services than you have now with Original Medicare. And, you will keep your Medicaid coverage.
4. Do I have to pick a Primary Care Physician?
Yes. Keystone 65 Complete is a managed care plan. That means all your health care goes through one main doctor (a Primary Care Physician) whom you pick when you join. You’ll see this doctor for most medical care. If you need to go to a specialist or to the hospital, your primary care doctor must coordinate it, except for emergency care. There’s a good chance your current doctor is already in our network.
5. Which doctors can I see?
Keystone 65 Complete has a network of doctors, specialists, and hospitals. You can use any doctor who is part of our network. You are even eligible for round-trip transportation to plan-approved providers at no cost to you.
6. Do I need a referral to see a specialist?
Yes. Keep in mind that your primary care physician coordinates all of your care except for emergencies. If you need to see a specialist, your primary care physician will give you a referral.
7. If I don’t join Keystone 65 Complete, will Medicaid still pay for my prescriptions?
No. As of January 1, 2006, Medicaid stopped paying for prescription drugs for people who have both Medicare and Medicaid. Now, Medicare pays for prescription drugs, but only if you are in a Medicare-approved plan like Keystone 65 Complete. With Keystone 65 Complete, you’ll pay $0 for generic drugs and $3.20 for brand-name drugs, and you can save money on many over-the-counter drugs.
8. The government picked my drug plan for me. Can I switch to Keystone 65 Complete?
Yes. Even if the government sent you a letter and told you what drug plan you are in, you don’t have to stay in it. You can switch to Keystone 65 Complete and get coverage plus many more health benefits than you have now — for $0 per month. All you need to do is send in a completed enrollment form. We will do the rest.
9. What programs does Keystone 65 Complete offer to help keep me healthy?
We believe it’s important for members to take an active role in their health care. We offer a full range of programs to help members live healthy and stay healthy, such as SilverSneakers® – a free fitness center membership; Healthy LifestylesSM– including smoking cessation and weight management; ConnectionsSM Health Management Programs; and more!
10. Do I have to send in my bills or claim forms?
No. In most cases, you’ll just show your Keystone 65 Complete ID card and your Medicaid ACCESS card. We will take care of the rest.
11. Do I qualify for low-income subsidy?
If you have limited income and resources, you may qualify for a low-income subsidy. When you join Keystone 65 Complete, Medicare will tell us how much extra help you are getting. Then, we will let you know the amount you will pay. If you qualify, your drug costs will also be lower.
You can see if you qualify for a low-income subsidy by calling:
- 1-800-MEDICARE (1-800-633-4227) (TTY/TDD: 1-877-486-2048), 24 hours a day/7 days a week
- Pennsylvania Office of Medical Assistance Programs (Medicaid) at 1-717-787-1870
- The Social Security Administration at 1-800-772-1213 (TTY/TDD: 1-800-325-0778), 7 a.m. to 7 p.m., Monday through Friday
12. How can I get more information?
Call us toll-free at 1-877-393-6733 (TTY/TDD: 1-877-219-5457), from 8 a.m. to 8 p.m., seven days a week. You can also request a home visit or attend one of our seminars at a location near you (check our Calendar for dates). For accommodations of persons with special needs, call the number above.