Medicare Platino
Medicare Platino is a Medicare Advantage Plan’s supplemental coverage, contracted by ASES, that covers the benefits and services not covered by Medicare.
Who qualifies?
Beneficiaries who have Medicare Parts A and B and are certified as Medicaid-eligible qualify for Medicare Platino benefits and services.
If you meet the following requirements:
Age
Be 65 years or older.
Eligibility
Be eligible for Medicaid and participate in Plan Vital.
Citizenship
Be a U.S. citizen or be lawfully present in the United States.
Service Area
Live in the Medicare Advantage plan’s service area.
Additional Information
Referrals and specialists
When a beneficiary is referred to a specialist by their primary care physician (PCP) and the specialist prescribes medications, the PCP's countersignature on the prescription is not required.
Where the Medicare Advantage Organization (MAO) contracts with primary medical groups (IPAs) that in turn have preferred specialist networks contracted directly by the IPAs, a PCP referral is not required when both are part of the same IPA. However, the specialist must inform the PCP about the medical services provided.
Beneficiaries may visit gynecologist/obstetrician and urologist specialists without a PCP referral.
A referral is not required for services related to pathology laboratories.
Notification and training
Each MAO must send the Explanation of Benefits (EOB) notice monthly, including a summary of its referral procedure, to all Medicare Platino beneficiaries to ensure the population is informed.
Each MAO must inform and train all primary care providers about its referral procedure and ensure those providers understand the process to guarantee coordination of their health care with specialists.
Medications and primary care
Bioequivalent medications are mandatory.
Beneficiaries 60 years or older may select a geriatrician as their PCP.