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PartnershipAdvantage (HMO SNP) - Frequently Asked Questions



What is PartnershipAdvantage?

PartnershipAdvantage is a health plan offered by Partnership HealthPlan of California (PHC) that combines your Medi-Cal and Medicare programs into one single health plan. You receive a membership card for all of your PHC Medi-Cal, Medicare and Medicare prescription drug ("Part D") care!

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What happens if I go to a doctor who is not in your network?

If you choose to go to a doctor outside our network, you must pay for these services yourself. Neither PartnershipAdvantage nor Original Medicare will pay for these services.

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Where can I get my prescriptions?

PartnershipAdvantage has a network of pharmacies. You can use any pharmacy in our network. We also have a free mail order service for most maintenance medications through the Walgreen's mail order service. For more information about your pharmacy benefit, our mail order service, or our pharmacy network, please contact our Member Services Department.

Refer to the section of this website titled "Contacting PartnershipAdvantage" for our hours, phone number and address.

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What happens if I go to a pharmacy that is not in your network?

If you go to a pharmacy that is not in our network, you might have to pay for your prescriptions. For more information, contact our Member Services Department.

Refer to the section of this website titled "Contacting PartnershipAdvantage" for our hours, phone number and address.

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What is a prescription drug formulary and does PartnershipAdvantage have one?

Yes. PartnershipAdvantage does have a prescription drug formulary. A formulary is a list of preferred drugs selected to meet patient needs. PartnershipAdvantage may periodically make changes to the formulary. All members affected by changes to the formulary will be notified in writing before the change is made.

If you have any questions or would like to request a copy of the formulary, please contact our Member Services Department.

Refer to the section of this website titled "Contacting PartnershipAdvantage" for our hours, phone number and address.

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What if I want to change my Primary Care Provider?

If you want to change your Primary Care Provider (PCP) you should contact our Member Services Department. Our Member Services staff will help you find another PCP in your area.

Refer to the section of this website titled "Contacting PartnershipAdvantage" for our hours, phone number and address.

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What should I do if I have a medical emergency?

Get medical help as quickly as possible. Call 911 for help or go to the nearest emergency room. You do not need to get permission first from your Primary Care Provider (PCP).

Make sure that your PCP knows about your emergency, because he/she will need to be involved in following up on your emergency care. You or someone else should tell your PCP about your emergency care as soon as possible, preferably within 48 hours. Your PCP's phone number is printed on the front of your membership card.

For more information about emergency and/or urgent care, refer to section 3 of your Evidence of Coverage or call our Member Services Department.

Refer to the section of this website titled "Contacting PartnershipAdvantage" for our hours, phone number and address.

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What if PartnershipAdvantage is no longer available?

If we leave the Medicare program or change our service area so that it no longer includes the area where you live, we will tell you in writing. If this happens, your membership in PartnershipAdvantage will end, and you will have to change to another way of getting your Medicare benefits. All of the benefits and rules described in this booklet will continue until your membership ends. This means that you must continue to get your medical care in the usual way through PartnershipAdvantage until your membership ends.

Your choices for how to get your Medicare will always include Original Medicare and joining a Prescription Drug Plan to complement your Original Medicare coverage. Your choices may also include joining another Medicare Advantage Plan, or a Private Fee-for-Service plan, if these plans are available in your area and are accepting new members. Once we have told you in writing that we are leaving the Medicare program or the area where you live, you will have a chance to change to another way of getting your Medicare benefits.

If you decide to change from PartnershipAdvantage to Original Medicare, you will have the right to buy a Medigap policy regardless of your health.

PHC has a contract with the Centers for Medicare & Medicaid Services (CMS), the government agency that runs Medicare. This contract renews each year. At the end of each year, the contract is reviewed, and either PHC or CMS can decide to end it. You will get 90 days advance notice in this situation. It is also possible for our contract to end at some other time during the year, too. In these situations we will try to tell you 90 days in advance, but your advance notice may be as little as 30 or fewer days if CMS must end our contract in the middle of the year.

Whenever a Medicare health plan leaves the Medicare program or stops serving your area, you will be provided a special enrollment period to make choices about how you get Medicare, including choosing a Medicare Prescription Drug Plan and guaranteed issue rights to a Medigap policy.

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