Do I Qualify?

Do I Qualify to Become a Member of Provider Partners Health PlanS?

To learn if you (or your loved one) are likely to qualify for the services offered by Provider Partners Health Plans, please answer the following questions. Our staff is happy to help you determine your eligibility. Just contact our Member Services number at 1-800-405-9681 for additional information. (TTY users should call 711). Hours are 8:00 A.M. to 8:00 P.M., seven days a week from October 1 through March 31; 8:00 A.M. to 8:00 P.M. Monday to Friday from April 1 through September 30.

1. Do you currently have Medicare Part A (hospital insurance) and Part B (medical insurance)?
2. Have you been a resident of a nursing home or skilled nursing facility for longer than ninety (90) days?
3. Do you live at home and the state that you reside in has certified that you need the type of care that is usually provided in a nursing home?

Who’s eligible?

You are eligible for membership in our plan as long as:

• You must be entitled to Medicare Part A and be enrolled in Medicare Part B.
• You live in one of our contracted nursing homes located in the service area listed below.

-OR-

• You live in one of our service areas below and the state has certified you need the type of care that is usually provided in a nursing home.
• You live in one of our service areas:
  • In Illinois, Provider Partners Health Plans covers care in 7 Illinois counties – Cook, DuPage, Kane, Lake, McHenry, Will, and Winnebago.
  • In Indiana, Provider Partners Health Plans covers care in 18 Indiana counties – Cass, DeKalb, Delaware, Elkhart, Hamilton, Hendricks, Howard, Johnson, Madison, Marion, Marshall, Monroe, Morgan, Porter, St. Joseph, Vanderburgh, Warrick, and Whitley.

• • In Maryland, Provider Partners Health Plans covers care in 16 Maryland counties – Allegany, Anne Arundel, Baltimore, Baltimore City, Caroline, Carroll, Dorchester, Frederick, Garrett, Harford, Howard, Kent, Queen Anne’s, Talbot, Washington, and Worcester.

• • In Missouri, Provider Partners Health Plans covers care in 65 Missouri counties – Audrain, Barry, Boone, Butler, Caldwell, Callaway, Camden, Cape Girardeau, Carroll, Cedar, Chariton, Christian, Clay, Clinton, Cole, Crawford, Dade, Dallas, DeKalb, Dent, Douglas, Franklin, Greene, Henry, Hickory, Howard, Iron, Jackson, Jasper, Jefferson, Laclede, Lafayette, Lawrence, Lincoln, Livingston, Madison, Maries, McDonald, Miller, Mississippi, Moniteau, Montgomery, New Madrid, Phelps, Platte, Polk, Pulaski, Ray, Reynolds, Ripley, St. Charles, St. Francois, St. Louis, St. Louis City, Saline, Scott, Stoddard, Stone, Taney, Texas, Vernon, Warren, Washington, Webster and Wright.

• • In North Carolina, Provider Partners Health Plans covers care in 6 North Carolina counties – Cabarrus, Davie, Forsyth, Gaston, Guilford, and Lincoln .

• • In Pennsylvania, Provider Partners Health Plans covers care in 17 Pennsylvania counties – Allegheny, Armstrong, Beaver, Bucks, Butler, Chester, Crawford, Delaware, Fayette, Greene, Lancaster, Lawrence, Mercer, Montgomery, Philadelphia, Somerset, and Westmoreland.
    
  • In Texas, Provider Partners Health Plans covers care in 82 Texas counties – Anderson, Angelina, Bandera, Bexar, Brazos, Brown, Burnet, Cass, Chambers, Cherokee, Collingsworth, Comanche, Concho, Cooke, Crane, Dallas, Delta, Denton, Ector, El Paso, Falls, Fannin, Fort Bend, Freestone, Goliad, Gray, Gregg, Grimes, Guadalupe, Hall, Hamilton, Hardin, Harris, Henderson, Hood, Hopkins, Howard, Hutchinson, Jefferson, Jim Wells, Karnes, Kaufman, Lavaca, Limestone, Lubbock, Madison, Matagorda, Maverick, McLennan, Medina, Midland, Moore, Nacogdoches, Navarro, Orange, Palo Pinto, Parker, Potter, Randall, Red River, Refugio, Robertson, Rockwall, Runnels, San Saba, Shelby, Smith, Somervell, Tarrant, Titus, Tom Green, Trinity, Tyler, Upshur, Uvalde, Val Verde, Victoria, Washington, Wichita, Williamson, Wise, and Young