If you are a Virginia Premier CompleteCare (Medicare-Medicaid Plan) member, you will now get all your covered Medicare and Medicaid services from Virginia Premier Health Plan, including prescription drugs. You do not pay extra to join this health plan and Virginia Premier CompleteCare does not charge a monthly premium.
- Your Medicare and Medicaid covered services must be provided according to the rules set by Medicare and Medicaid.
- The services (including medical care, services, supplies, equipment, and drugs) must be medically necessary. Medically necessary means you need the services to prevent, diagnose, or treat a medical condition.
- You get your care from a network provider. A network provider is a provider who works with the health plan. Chapter 3, Section D of the Member Handbook has more information about using network and out-of-network providers.
- You have a primary care provider (PCP) or a care team that is providing and managing your care. In most cases, your PCP must give you approval before you can see other network providers. This is called a prior authorization. Chapter 3, Section B of the Member Handbook has more information about getting a prior authorization and explains when you do not need a prior authorization.
- Some services are covered only if your doctor or other network provider gets approval from us first. This is called prior authorization. Please see Chapter 4 of the Member Handbook for more information.
*Patient Pay Information (this is the only situations where a patient has co-pay or there is a cost-sharing):
For Elderly or Disabled with Consumer Direction (EDCD) and Long-Term Services and Supports (LTSS), you may have a patient pay. When your income exceeds an allowable amount, you must contribute toward the cost of your long term care services. This contribution, known as the patient pay amount, is required if you live in a nursing facility or receive EDCD Waiver services. However, you might not end up having to pay each month.
To get EDCD services, the State has to make sure you meet certain criteria. If you need EDCD waiver services, you can contact Virginia Premier CompleteCare at 1-855-338-6467 to ask about the process for applying for these services. You can also call the State’s Long Term Care Division at 804-225-4222 for additional information.
- Tier 1 drugs are generics with a co-pay of $0.00, $1.20, or $2.65, depending on your income and institutional status.
- Tier 2 drugs are brand with a co-pay of $0.00, $3.60, or $6.60, depending on your income and institutional status.
- Tier 3 are Non-Medicare Rx/OTC drugs with a $0.00 co-pay.
Have Questions? Let’s talk.Call us at 1-855-338-6467, 8:00 a.m. to 8:00 p.m., Monday through Friday. For TTY/TDD services, please call 1-800-828-1120 (Text), 1-800-828-1140 (Voice). The call is free.
Virginia Premier CompleteCare is a health plan that contracts with both Medicare and the Virginia Department of Medical Assistance Services to provide benefits of both programs to enrollees.
Limitations, copays, and restrictions may apply. For more information, call Virginia Premier CompleteCare Member Services or read the Virginia Premier CompleteCare Member Handbook.
Benefits, List of Covered Drugs, and pharmacy and provider networks and/or copayments may change from time to time throughout the year and on January 1 of each year.
You can get this information for free in other languages. Call 1-855-338-6467, 8:00 a.m. to 8:00 p.m., Monday through Friday. For TTY/TDD services, please call 1-800-828-1120 (Text), 1-800-828-1140 (Voice). The call is free.
You can ask for this information in other formats, such as Braille or large print. Call 1-855-338-6467, 8:00 a.m. to 8:00 p.m., Monday through Friday. For TTY/TDD services, please call 1-800-828-1120 (Text), 1-800-828-1140 (Voice).
H3067_010115.2WEB CMS Approved