Frequently Asked Questions

• What happens if I lose Passport Health Plan?
• What do I do if I get a bill from a provider?
• What do I do if I paid too much for my medicine?
• What can I do if Passport Advantage doesn't cover my medicine?
• What can I do if my provider is not in the Passport Advantage network?

You must be a Passport Health Plan member to become a member of Passport Advantage. Kentucky Medicaid decides if you are in Passport Health Plan.

If Kentucky Medicaid takes you out of Passport Health Plan and you think the decision was wrong, please call your local Department for Community Based Services (DCBS).

If you lose Passport Health Plan, you can choose to stay in Passport Advantage for up to 3 months.

During these 3 months, 2 things could happen:

1. Kentucky Medicaid could put you back into Passport Health Plan within 3 months. This means you can stay in Passport Advantage.
2. Kentucky Medicaid could decide to not put you back into Passport Health Plan within 3 months. This means that you will no longer be a member of Passport Advantage after these 3 months. We will send you a letter, and then you will need to choose another Medicare plan to get your prescription drugs.

Most of the time, you do not have to submit claims to Passport Advantage. Usually, your provider will bill us. If you get a bill from a provider, call Member Services right away! We will look into the situation and help you get the most out of your benefits.

If you think you paid too much for your medicine, call Member Services! You can ask us to reimburse you by submitting a paper claim form.

You should never pay more than $6.30 for a medicine in 2010!

Sometimes, we may just need a prior authorization. This means that we must look at your case and approve the medicine before the pharmacy can give it to you.

Other times, there may be a generic medicine that you will need to try before you use a brand name medicine. Also remember there are drugs that are not covered by your Medicare benefits, but they may be covered by your Medicaid benefits with Passport Health Plan.

If you think we should cover a medicine that is not covered, please call Member Services. There is a process to see if Passport Advantage will pay for medicines in certain situations.

If your provider is not in the Passport Advantage network, call Member Services! We can try to work with your provider to see if they would like to join our network. We can also suggest other plan providers who might be a good fit for you.

You can continue to go to your non-plan provider if he or she accepts Kentucky Medicaid and Medicare… however, you might have to pay more out of pocket. To make sure your services are covered, please try to go to a plan provider.