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An Economical Plan for People With Medicare

CommunityCare is proud to offer Senior Health Plan, a program created especially for Medicare beneficiaries. CommunityCare Senior Health Plan is a Federally-Qualified HMO with a Medicare contract and is owned by Saint Francis Health System and St. John Health System in Tulsa (other physicians and providers are available in our network). Senior Health Plan's contract with CMS is renewed annually. As a result, the availability of coverage beyond the end of the current contract year is not guaranteed. Benefits, limitations, service areas and premiums are subject to change on January 1 of each year.

Quality Improvement Organization

The Centers for Medicare and Medicaid Services (CMS) announced that, effective August 1, 2014, it has chosen KEPRO to serve as Medicare's new Beneficiary and Family-Centered Care Quality Improvement Organization (BFCC-QIO) for 15 states including Oklahoma. BFCC-QIOs are in charge of conducting quality of care reviews, discharge and termination of service appeals and other types of quality reviews. KEPRO is an independent group of doctors and other health care experts that is paid by the Federal government, and is not affiliated with CommunityCare. Before August 1st, the Oklahoma Foundation for Medical Quality (OFMQ) served as the QIO for Oklahoma.

Starting August 1st, Senior Health Plan members should talk with KEPRO in any of these situations:

  • You have a complaint about the quality of care you have received.
  • You think coverage for your hospital stay is ending too soon.
  • You think coverage for your home healthcare, skilled nursing facility care, or Comprehensive Outpatient Rehabilitation Facility (CORF) services are ending too soon.

KEPRO can be reached at this address: 5700 Lombardo Center Drive, Suite 100, Seven Hills, OH 44131. The phone number for KEPRO is 1-844-430-9504.

You may always call CommunityCare with any questions or concerns. Member Services can be reached at 1-800-642-8065. TTY users should call 1-800-722-0353. Our hours are Monday-Friday, 8 a.m.–8 p.m. CST.

Medication Therapy Management (MTM) Programs

CommunityCare Senior Health Plan offers a medication therapy management program. Its purpose is to help you receive the most effective medications while helping to reduce the risk of side effects and interactions as well as your out-of-pocket costs.

CommunityCare Senior Center

At our CommunityCare Senior Center you can learn more about Senior Health Plan, receive help with enrollment, receive customer service and attend health education classes.

Senior Health Plan Resources

For details on Benefits Information, Grievance & Appeals Procedures, Out-of-Network Coverage, Quality Assurance Policies, Rights & Responsibilities Upon Disenrollment, and Applicable Conditions and Limitations, select the Evidence of Coverage booklet that corresponds with your plan from the "Forms & Resources" section of this site. These booklets provide details about your Medicare health coverage and explain how to get the care you need for your plan.


Senior Health Plan Service Areas

Our service area includes Creek County, Rogers County, Tulsa County, and Wagoner County in Oklahoma.

Although Medicare is a Federal program, Senior Health Plan is available only to individuals who live in our plan service area. To stay a member of our plan, you must keep living in this service area. The service area is described below:

Our service area includes these counties in Oklahoma: Creek, Rogers, Tulsa, and Wagoner Counties.

Our service area includes these parts of counties in Oklahoma: Osage County, (the following zip codes only): 74002, 74035, 74054, 74060, 74063, 74070, 74084, 74126, and 74127; Washington County, (the following zip codes only): 74003, 74005, 74006, 74029, 74051, 74061, 74070.

If you plan to move out of the service area, please contact Member Services.

Disclaimers

  • You may join or leave a plan only at certain times. Please call Senior Health Plan at the telephone number listed in the previous section of this web page or 1-800-MEDICARE (1-800-633-4227) for more information. TTY users should call 1-877-486-2048. You can call this number 24 hours a day, seven days a week.
  • You can join Senior Health Plan if you are entitled to Medicare Part A and enrolled in Medicare Part B and live in the service area. However, individuals with End Stage Renal Disease are generally not eligible to enroll in Senior Health Plan unless they are members of our organization and have been since their dialysis began.
  • Senior Health Plan has formed a network of doctors, specialists, and hospitals. You can only use doctors who are part of our network. The health providers in our network can change at any time. You can ask for a current Provider Directory for an up-to-date list or search the Senior Health Plan provider directory on this website. If you choose to go to a doctor outside of our network, you must pay for these services yourself. Neither Senior Health Plan nor Original Medicare will pay for these services.
  • You must continue to pay your Medicare Part B premium, even if the Senior Health Plan premium is $0.