AbilityCare (HMO SNP)
AbilityCare Coverage and Eligibility
AbilityCare is a Medicare Advantage Special Needs BasicCare (SNBC) program for people with disabilities who live in our 12-county service area. AbilityCare is designed to help people with disabilities access the health care, medications, and support services they need. There are no additional costs to join AbilityCare.
To be eligible for AbilityCare you must:
- Be certified disabled by the Social Security Administration or State Medical Review Team (SMRT);
- Be at least 18 and under the age of 65 at the time of enrollment;
- Be eligible for Medical Assistance;
- Have Medicare Parts A and B;
- Live in our service area (see service area map) .
AbilityCare eligibility is determined by a financial worker in your county.
AbilityCare provides Medicare Part A (hospital), Part B (medical), Part D (prescription drug), and Medical Assistance coverage.
You do not pay a separate monthly plan premium for AbilityCare. You must continue to pay your Medicare Part B premium (unless your Part B premium is paid for you by Medical Assistance (Medicaid) or another third party).
- A large network of providers where members can receive care without referrals
- A Community Care Connector located in the county who helps members get the services and supports they need
- Nurse24 nurse advice line and online support, available 24/7
- Care Coordination services
Did you know that annual screening for Human Immunodeficiency Virus (HIV) is a covered benefit for South Country Health Alliance members? Call Member Services for specific benefit information. If you are at risk, be safe and get tested!
Not a Member Yet?
There are many more benefits to being an AbilityCare member, and the best part is, there is no extra cost to you! See How to Enroll for more information. Or, if you wish to speak with someone about your enrollment questions, please call the number below. We are happy to help!
Enrollment Questions and Assistance
You may end your membership in our plan at any time. Ending your membership in our plan may be voluntary (your own choice) or involuntary (not your own choice). For more information, see Chapter 10 in the Evidence of Coverage (under Member Materials to the right).
Member Rights and Responsibilities
For Member Rights and Responsibilities, see Chapter 8 in the Evidence of Coverage (under Member Materials to the right).
More Information for AbilityCare
|AbilityCare Member Materials|
|Evidence of Coverage||2019 PDF||2020 PDF|
|Annual Notice of Changes||2019 PDF||2020 PDF|
|Summary of Benefits||2019 PDF||2020 PDF|
|Pre-Enrollment Checklist||2019 PDF||2020 PDF|
|List of Covered Drugs (Formulary)||2019 PDF||2020 PDF|
|Formulary Updates||November 2019||N/A|
|Provider and Pharmacy Directory||Web Page|
|Medicare Star Ratings||2019 PDF||2020 PDF|
|LIS Premium Summary Chart||2019 PDF||2020 PDF|
|CMS Best Available Evidence Coverage||Web Page|
|Covered Diabetic Testing Supplies||2019 PDF||2020 PDF|