Medicare Part D: The Medicare prescription drug benefit program. We call this program “Part D” for short. Medicare Part D covers outpatient prescription drugs, vaccines, and some supplies not covered by Medicare Part A or Medicare Part B or Medical Assistance. Our plan includes Medicare Part D.Medicare Part A: The Medicare program that covers most medically necessary hospital, skilled nursing facility, home health, and hospice care.
Medicare Part B: The Medicare program that covers services (such as lab tests, surgeries, and doctor visits) and supplies (such as wheelchairs and walkers) that are medically necessary to treat a disease or condition. Medicare Part B also covers many preventive and screening services.Medical Assistance: This is the name of Minnesota’s Medicaid program. Medical Assistance is run by the state and is paid for by the state and the federal government. It helps people with limited incomes and resources pay for long-term services and supports and medical costs.
It covers extra services and some drugs not covered by Medicare. Medicaid programs vary from state to state, but most health care costs are covered if you qualify for both Medicare and Medicaid.

Grievances (Complaints)

Filing a Grievance

A grievance is any complaint you may have other than one that involves a Coverage Determination. You must file a grievance either orally or in writing no later than 60 days after the event or incident that led to the grievance. These are some examples of the types of problems that may lead you to file a grievance:

  • You feel that you are being encouraged to leave (disenroll from) AbilityCare.
  • There are problems with the service you receive.
  • You wait too long on the phone or in the pharmacy.
  • There are problems with the cleanliness or condition of pharmacy.
  • You disagree with our decision not to give you a "fast" Coverage Determination or Appeal.

You will receive a response within:

  • 24 hours if your grievance involves a refusal to give you a "fast" Coverage Determination or Appeal.
  • 30 calendar days for all other grievances. We may extend the timeline by up to 14 calendar days if you ask for an extension or we justify a need for additional information and the delay is in your best interest.

If you have a grievance, you may call Member Services.

You can also mail your grievance to:

South Country Health Alliance
Appeals & Grievances Department
6380 West Frontage Road
Medford, MN 55049

While we encourage you to contact South Country Health Alliance Member Services first when you have a grievance, you can also tell Medicare about your grievance directly by visiting the Medicare website (external link).

 

H5703_5772 Accepted 8/9/21

More Information

AbilityCare Member Materials
2024 MaterialsLast Updated
Enrollment FormPDF11/22/23
Member Handbook
PDF10/15/23
Annual Notice of ChangesPDF10/15/23
Summary of BenefitsPDF10/15/23
Pre-Enrollment ChecklistPDF10/5/23
List of Covered Drugs (Formulary)PDF4/1/24
Formulary UpdatesPDF4/1/24
Provider and Pharmacy DirectoryWeb PageSee link
Medicare Star RatingsPDF (English)
PDF (Español)		10/23/23
LIS Premium Summary ChartPDF10/15/23
CMS Best Available Evidence CoverageWeb Page (external link)
Covered Diabetic Testing SuppliesPDF11/17/23

Last Updated on 12/02/2021 by Chris Gartner

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