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.

Will I get billed as a South Country member?

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South Country pays for almost all medically necessary care you would receive. South Country members generally should never be billed by a provider – there are very few exceptions such as copays. However, sometimes it happens – here is what you should do if you are unexpectedly billed for health care.

If you get a bill from any provider, the first thing you should do is call Member Services to ask about it. South Country is not allowed to pay you back for most bills if you pay them yourself, so it is best to ask us first before you make ANY payment to your provider. We also do not allow our contracted providers to “balance bill” our members. This is when South Country pays the fee we and the provider agreed to in our contract but then the provider tries to collect from you anything else they think they are owed.

There are steps you can take to prevent an unexpected bill:

  1. Show your South Country member ID card every time you get a health care service at the clinic, pharmacy, dentist, chiropractor or any other provider. Ask the provider to make a copy for their records if they don’t automatically do it.
  2. Before you get a service, ask if your provider accepts South Country Health Alliance insurance. Some Minnesota providers and most out-of-state providers are not contracted with South Country and not all providers will accept our plan. Except for emergencies and urgent care, if you use these providers without getting our approval first, you will have to pay the bill yourself.
  3. Call Members Services if the provider asks you to pay and you don’t think you should. Or ask the provider to call us or the provider contact center number on you ID card. Do this even if you are at the provider or pharmacy. Remember we generally cannot pay you back for anything you pay the provider yourself.
  4. Read the handbook for the plan you are on. Details about any costs you may have are shown in your handbook. We post the handbooks at mnscha.org and will send you a free printed copy if you ask for it.
  5. If you get a bill, do not ignore it. Call Member Services immediately and tell us about it. We can advise you how to proceed. Chances are the provider has billed you by mistake.
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