Medicare and Other Insurance

If you qualify for Medicare, call your DDD Support Coordinator who will update their records and let everyone know.

If you are a Qualified Medicare Beneficiary, you are eligible to get more benefits. These benefits include respite services, chiropractic services, outpatient occupational therapy services and any other services covered by Medicare but not covered by Capstone Health Plan. Additional information about Medicare can be found in the Medicare handbook "Other Things You Should Know About Medicare". This handbook is available through your local Social Security office.

If you have Medicare or other insurance, Capstone will pay for covered services Medicare does not pay. It is important that you tell your PCP, Capstone and your DDD Support Coordinator about your other health insurance benefits.

Your PCP must bill your other insurance first. Capstone will pay for any outstanding covered services. Please be sure to give your PCP your Capstone information.

If you are covered by Medicare, Capstone Health Plan will no longer be able to pay for the majority of your medications beginning January 1, 2006. After this date you must get your medications through a Medicare contracted Prescription Drug Plan (PDP). Capstone Health Plan will continue to pay for some medications not included in the Medicare pharmacy benefit. The medication categories that Capstone will continue to cover are:

Benzodiazepines: Commonly used medications in this category include Valium© (generic name diazepam), Ativan© (generic name lorazepam) and others.
Barbiturates: A commonly used medication in this category is phenobarbital.
Medically necessary over-the-counter medications.

There are some exceptions to this coverage. You must continue to obtain any benzodiazepines or barbiturates through the behavioral health system (NARBHA) or CRS (Children's Rehabilitation Services) if those agencies are currently providing those medications to you.

NOTE: You will not lose Capstone services if you have Medicare and other private/commercial insurance.

With Medicare, private insurance and Capstone you have three companies working together to help you with your health care needs!

Please report changes in your benefit eligibility to your DES-DDD Support Coordinator.