Asthma and COPD Support

Individual care to help control your asthma or COPD.

You may qualify for care management services if you have asthma or COPD. Including respiratory equipment and supplies.

Choice of Doctor

You will have a primary care physician (PCP) who will be your main doctor. Your PCP is the person you should see for most of your care. This includes checkups, treatments, vaccinations, minor injuries and health concerns. Talk to your PCP about any behavioral health concerns you may have. Your PCP can help you decide the right options for you.

Your PCP is your main doctor for:

• Preventive care.
• Treatment if you are sick or injured.
• Referrals to specialists for certain conditions.

Use the Doctor Lookup tool to see if your doctor is in our network. If you don’t have a doctor or if your doctor is not in our network, we can help you find a new one close to you.
 

Choose a Birth Center

Where you have your baby is an important choice. That's why you can pick from a large network of hospitals across Kentucky.

We also encourage you to tour the hospital's birthing center. This way you will be familiar with it. And you'll be more relaxed when you have your baby.

Dental

• For adults, one cleaning per 12 month period
• For children under 21, one cleaning per 6 month period
• Extractions
• One set of standard x-rays every 12 months
• Children under age 21 receive additional benefits: fluoride treatments, sealants, fillings
• Dental emergency for adults/children

Diabetes Support

If you have diabetes, we'll help make life a little easier for you. You'll get medicine, supplies and education to help you reach and stay your best. You are also rewarded with gift cards for taking simple steps to manage your diabetes.

If you experience a hospital stay and have diabetes or pre-diabetes, you are eligible to receive 14 home delivery meals post discharge.

Our diabetes program also includes self-care training and classes focused on:

• Planning healthy meals.
• Managing stress.
• Living a healthy lifestyle.

Equipment and Medical Supplies

Your health and safety at home are important.

Our plan covers medical equipment ordered by your doctor. This can include supplies like:

• Hospital beds.
• Oxygen tanks.
• Wheelchairs or walkers.

Foot Care

If you have diabetes or a circulatory condition, good foot care can help prevent much more serious problems. We provide the needed exams to help keep your feet in great shape.

Our podiatry coverage includes routine foot exams for certain conditions.

Healthy First Steps®

When you're pregnant, you receive help and advice from your mom, aunts, sisters and girlfriends. Yet every pregnancy is different. This program will support you through your pregnancy. Get pregnancy and parenting support by calling (toll-free) 1-800-599-5985 (TTY 711).

We can help you:

• Find a doctor for both mother and baby.
• Learn about nutrition, fitness and safety.
• Find out what extra rewards you could be eligible for.

Home Health Care

After surgery or a serious illness—or if you have a disability—you may need extra help with day-to-day tasks. With approval, and ordered by your doctor, our plan covers:

• Time-limited skilled nursing services
• Specialized therapies, including physical therapy, speech-language pathology and occupational therapy
• Home health aide services (help with activities such as bathing, dressing, preparing meals and housekeeping)
• Medical supplies 

Hospitalization

This plan pays for all expenses related to a hospital stay, so you can rest and heal.

Our plan covers:

• Inpatient care
• Outpatient care
• Labs, X-rays and other tests

And after you leave the hospital, you are not alone. We make sure you get follow-up care to continue healing at home.

Interpreters

Your doctor and you need to understand each other. Not speaking English well makes this difficult. We can arrange for a medical interpreter to be at your appointments.

We also have people in member services who speak more than one language. Chances are, we have someone who speaks your language or they can connect you with our interpreter service which covers more than 170 languages.

Kidney Disease Care

Kidney disease is a serious medical condition. After the kidneys stop working, regular treatments, called renal dialysis or an organ transplant are needed to live. Dialysis uses a machine to clean the blood just like healthy kidneys do.

Our plan includes:

• Dialysis.
• Medications.
• Health education and support.
• Organ transplant if needed.

Lab & X-rays

Knowing what's wrong and finding it early can make all the difference. Our plan covers:

• Labs and testing.
• X-rays, scans and other imaging.

We'll help you get the information needed to improve your health or be at your best.

Language Help

You can receive information in your preferred language. Just ask. We also have people at our customer service centers who speak more than one language. Chances are, we have someone who speaks your language or they can connect you with our interpreter service which covers more than 170 languages.

Medicines

Our plan includes prescription drugs and refills with no copays. We also cover over-the-counter medicines with a written order from your doctor.

And we make getting your medicine easy. You can fill your prescriptions at:

• Local pharmacies.
• Services that deliver routinely right to your door.

Member Services

Sometimes you might need a little help understanding your health care options. With us, you have someone you can call. We’ll answer your questions simply and completely.

We can also help you find:

• Home care providers.
• Dentists and vision providers.
• Help finding housing, transportation and other community services.

Mental Health Services for Children and Youth

Problems such as depression and anxiety can also be challenging for children and teens.

There are no costs for covered services. We have therapists and doctors for youth and teens that can address their specific behavioral health or substance use. Help get them extra support to live a heathier life.

Additional Resources:

Teens can connect with teens during specific hours: 1-866-833-6546, teenlink@crisisclinic.org, www.866teenlink.org.

Dailystrength.org is an online support resource that provides over 500 support communities for people facing similar life challenges, medical conditions and mental health issues.

No Cost for Covered Services

Get the quality health care you deserve at no cost for covered services. You get:

• Care from highly skilled and compassionate doctors.
• Treatments at respected hospitals and clinics.
• Home medical equipment and supplies to help you be at your best.

NurseLine℠

Medical questions and situations sometimes happen at inconvenient times. When you have questions about your health, you can call a nurse 24 hours a day, 7 days a week: 1-800-985-3856 (TTY 711).

Our nurses will:

• Listen to symptoms.
• Help with self-care.
• Advise you about getting care at a doctor visit or an urgent care center.
• Help you know when to go to the emergency room.

Nurse Visits

Sometimes continued care is needed after leaving the hospital or urgent care. For example, after a serious illness, surgery or injury. In these cases, a nurse will make home visits to:

• Provide medical care.
• Answer any questions and concerns.

Personal Care

Sometimes the basics are hard to do yourself after an illness or injury.

If needed and ordered by a doctor, we provide someone to help with:

• Dressing.
• Bathing.
• Feeding.

Personal Care Manager

Do you or a family member have a serious health problem? If your health needs qualify then our care managers are in your corner. They will:

• Help manage your physical and mental health care needs.
• Work with your physician, behavioral health specialists and outside agencies.
• Coordinate your doctor appointments.
• Provide your care team with your medical records.

Your care manager will stay with you throughout the medical journey. He or she will:

• Make sure you have support at home.
• Connect you to the social services you may need.

Prenatal Visits

Your pregnancy is a journey you'll want to make with the help of friends, family and a pregnancy doctor, or OB-GYN. With our plan, you also will be rewarded with gift cards for prenatal and postpartum doctor visits.

All recommended prenatal clinical visits and tests are covered by our plan.

At these visits, the clinic will:

• Make sure both you and your baby are healthy.
• Explain what to expect at each stage of your pregnancy.
• Answer your questions.

Programs for Kids and Teens

Kids with positive role models make more healthy choices. That's why we provide free memberships to the Boys & Girls Clubs in your area.

Along with fun and games, these clubs offer help with:

• Homework.
• Mentoring.
• Coaching.

Quitting Tobacco

You know the bad health effects of smoking. You know you need to quit. We support you while you quit with coaches and supplies. The only thing you won't get from us is a lecture. Call 1-866-QUIT-4-LIFE (1-866-784-8454) Or visit www.quitnow.net.

Residential Care

After a serious illness, surgery or injury you may need extra nursing and therapy. If needed, our plan covers short stays in a rehabilitation center where you can heal. Included are:

• Nursing home services.
• Help with activities of daily living.
• Physical, occupational and speech therapy.

Shots and Vaccines

Routine shots help protect you from illness.

Our plan covers:

• Recommended shots and vaccines.
• Influenza shots.

Therapy Services

Physical, occupational and speech therapy can help you recover from a serious injury or illness, or simply reach your full potential.

Our plan provides:

• Occupational therapy.
• Physical therapy.
• Speech therapy.
• In-home therapy.

Transportation

Transportation services:

• Emergency: If you need emergency transportation (an ambulance), call 911.
• Non-emergency: Non-emergency medical transportation is available if you can’t get a free ride to a covered service.

How to get non-emergency transportation

Kentucky Medicaid will pay to take some members to get medical services covered by Kentucky Medicaid. If you need a ride, you must talk to the transportation broker in your county to schedule a trip.

Each county in Kentucky has a transportation broker. You can only use the transportation broker for a ride if you can’t use your own car or don’t have one. If you can’t use your car, you have to get a note for the transportation broker that explains why you can’t use your car. If you need a ride from a transportation broker and you or someone in your household has a car, you can:

• Get a doctor’s note that says you can’t drive.
• Get a note from your mechanic if your car doesn’t run.
• Get a note from the boss or school official if your car is needed for someone else’s work or school.
• Get a copy of the registration if your car is junked.
• Kentucky Medicaid doesn’t cover rides to pick up prescriptions.

For a list of transportation brokers and their contact information, please visit the website https://transportation.ky.gov/TransportationDelivery/Pages/Human-Services-Transportation.Aspx   or call Kentucky Medicaid at 1-800-635-2570. For more information about transportation services, call the Kentucky Transportation Cabinet at 1-888-941-7433.

The hours of operation are 8:00 a.m. to 4:30 p.m. ET, Monday through Friday; and 8:00 a.m. to 1:00 p.m. ET, Saturday. If you need a ride, you have to call 72 hours before the time that you need the ride. If you have to cancel an appointment, call your broker as soon as possible to cancel the ride.

You should always try to go to a medical facility that is close to you. If you need medical care from someone outside your service area, you have to get a note from your PCP. The note has to say why it is important for you to travel outside your area. (Your area is your county and the counties next to it).

Vision Care

You'll get the care and treatment that let you see life more clearly. Coverage includes:

• Annual vision exam for adults and children.
• Lenses, frames and repairs are covered for those under 21 years and pregnant women.

Well Visits

Well visits with your doctor can help you stay healthy. These visits can catch health problems early, so they can be treated. Preventive services include:

• Checkups for children.
• Screenings for adults.
• Well-baby care.
• Care for women expecting a baby.
• Routine shots and tests.
• Mammograms.

There are no copayments for preventive care.