Guest - Frequently Asked Questions

Have Questions?
Care1st has Answers.

If you're thinking about joining a new health plan, we know you'll probably have many questions. Care1st Member Services Representatives will be happy to answer all your questions face-to-face at any of our meetings. Or you can call our Member Services Department and get help from our knowledgeable staff:

  • 1 (800) 544-0088 (Medicare)
    8:00 a.m. to 8:00 p.m., seven days a week
  • 1 (800) 544-0088 (Commercial)
    8:00 a.m. to 6:00 p.m., Monday through Friday
  • 1 (800) 605-2556 (Medi-Cal)
    8:00 a.m. to 6:00 p.m., Monday through Friday
  • 1 (855) 905-3825 (Cal MediConnect)
    8:00 a.m. to 8:00 p.m., seven days a week.

(TTY) 711 – hours same as above

Frequently Asked Questions

Start here to get answers to some of the questions that are most often asked.

MEDICARE | MEDI-CAL | CAL MEDICONNECT

MEDICARE


What are the different parts of Medicare (A, B, C, D)?

Medicare Part A covers inpatient hospital care, skilled nursing facility, home health care and hospice care. Part A is free if you or your spouse paid Medicare taxes while working.
Medicare Part B covers outpatient care, such as doctor's office visits, specialist's office visits, lab services, durable medical equipment and preventive services. You pay a Part B premium each month.
Medicare Part C are Medicare Advantage plans which are approved by Medicare and offered by private companies. Medicare Advantage Plans provide all of your Part A and Part B coverage. Medicare Advantage plans may offer extra coverage, such as vision, hearing, dental and/or health and wellness programs.
Medicare Part D is your prescription drug coverage. To get prescription drug coverage you must join a plan such as Care1st. Each plan can vary in cost and drugs covered.

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How can I join Care1st's Medicare Advantage Plans?

This is how you can join Care1st:

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How can I obtain specialty services?

When you need specialty care or additional services your PCP cannot provide, he or she will give you a referral. There are certain services which you can get on your own, without a referral as long as you get them from a network provider. These services include:

  • Routine women’s health care.
  • Flu shots and pneumonia vaccinations.
  • Dialysis (kidney) services.

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How can I get a new ID card, update my address, change my PCP or contact Member Services?

Call Member Services at 1-800-544-0088 from 8:00 a.m. to 8:00 p.m.  7 days a week to order a new ID card, update your address and change your PCP.

  • (TTY) 1-800-735-2929
    Seven days a week, 8:00 a.m. to 8:00 p.m. Pacific time

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I understand Care1st offers transportation services, How can I arrange for a ride?

You are covered for transportation services to all routine, specialty, laboratory, and dental medical appointments. Some restrictions may apply. Please call the Care1st Transportation Department at:

  • 1-87RIDEC1ST (1-877-433-2178)
    From 8:00am to 5:00pm., Monday through Friday, at least 24 hours in advance.
  • (TTY) 1-800-735-2929
    Seven days a week, 8:00 a.m. to 8:00 p.m. Pacific time

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What should I do if I’m out of Care1st's coverage area and need emergency services?

Care1st provides worldwide emergency coverage. If you have an emergency when you are not in our service area, you can obtain emergency services at the nearest emergency facility (doctor’s office, clinic or hospital). Emergency services do not require a referral or an okay from your PCP doctor.

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How can I obtain care after normal business hours?

It is important you always carry your Care1st ID card with you. If you think you have an emergency, call 911 or go to the nearest emergency room. Call your doctor if you need medical care, and he or she can help you arrange care. Care1st also offers a Nurse Advice Line. The call is free and easy. You get advice right away. A registered nurse will ask about your health problem. You do not have to call the Nurse Advice Line before getting healthcare. Care1st Nurse Advice Line:

  • 1-800-544-0088
    8 a.m. to 8 p.m., seven days a week

(TTY) 1-800-735-2929 – hours same as above

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What if I’m a Medicare member with Care1st and also have Medi-Cal benefits else where?

If you are a Medi-Cal member and eligible for Medicare, then it is important to know that Medicare, not Medi-Cal is your primary insurance. If you are interested in combining your benefits, please call Member Services for more information on the additional benefits available.

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What should I do if I receive a bill for covered services?

Care1st Health Plan has various plan options, which include different co-payments depending on your specific plan. You should not receive a bill for any covered services other than your co-payments. If you do, please call Member Services at 1-800-544-0088.

  • 1-800-544-0088
    8 a.m. to 8 p.m., seven days a week

(TTY) 1-800-735-2929 – hours same as above

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How is my private health information protected?

There are federal and state laws that protect the privacy of your medical records and personal health information. We protect your personal health information under these laws. Any personal health information that you give us when you enroll in this plan is protected. We will make sure that unauthorized people don’t see or change your records. If you have questions or concerns about privacy of your personal information and medical records, please call Member Services.

  • 1-800-544-0088
    8 a.m. to 8 p.m., seven days a week

(TTY) 1-800-735-2929 – hours same as above

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What benefits and services are not covered?

Our plan covers all of the medically-necessary services that are covered by Medicare Part A and Part B. The following items and services aren’t covered under the Original Medicare Plan or by our plan:

  • Services that aren’t reasonable and necessary, according to the standards of the Original Medicare Plan, unless these services are otherwise listed by our Plan as a covered service
  • Experimental or investigational medical and surgical procedures, equipment and medications, unless covered by the Original Medicare Plan or unless, for certain services, the procedures are covered under an approved clinical trial
  • Surgical treatment of morbid obesity unless medically necessary and covered under the Original Medicare plan
  • Private room in a hospital, unless medically necessary
  • Private duty nurses
  • Personal convenience items, such as a telephone or television in your room at a hospital or skilled nursing facility
  • Nursing care on a full-time basis in your home
  • Custodial care unless it is provided in conjunction with covered skilled nursing care and/or skilled rehabilitation services. This includes care that helps people with activities of daily living like walking, getting in and out of bed, bathing, dressing, eating and using the bathroom, preparation of special diets, and supervision of medication that is usually self-administered
  • Homemaker services
  • Charges imposed by immediate relatives or members of your household
  • Meals delivered to your home
  • Elective or voluntary enhancement procedures, services, supplies and medications including but not limited to: Weight loss, hair growth, sexual performance, athletic performance, cosmetic purposes, anti-aging and mental performance unless medically necessary
  • Cosmetic surgery or procedures, unless needed because of accidental injury or to improve the function of a malformed part of the body. All stages of reconstruction are covered for a breast after a mastectomy, as well as for the unaffected breast to produce a symmetrical appearance
  • Chiropractic care is generally not covered under the Plan, (with the exception of manual manipulation of the spine,) and is limited according to Medicare guidelines
  • Orthopedic shoes unless they are part of a leg brace and are included in the cost of the brace. Exception: Therapeutic shoes are covered for people with diabetic foot disease
  • Supportive devices for the feet. Exception: Orthopedic or therapeutic shoes are covered for people with diabetic foot disease
  • Radial keratotomy, LASIK surgery, vision therapy and other low vision aids and services
  • Self-administered prescription medication for the treatment of sexual dysfunction, including erectile dysfunction, impotence, and anorgasmy or hyporgasmy
  • Reversal of sterilization procedures, sex change operations, and non-prescription contraceptive supplies and devices
  • Acupuncture
  • Naturopath services
  • Non-emergency services provided to veterans in Veterans Affairs (VA) facilities. However, in the case of emergency services received at a VA hospital, if the VA cost-sharing is more than the cost-sharing required under our Plan, we will reimburse veterans for the difference. Members are still responsible for our Plan cost-sharing amount
  • Any of the services listed above that aren’t covered will remain not covered even if received at an emergency facility. For example, non-authorized, routine conditions that do not appear to a reasonable person to be based on a medical emergency are not covered if received at an emergency facility

If you are unsure if a benefit is covered please contact Member services for more assistance.

  • 1-800-544-0088
    8 a.m. to 8 p.m., seven days a week

(TTY) 1-800-735-2929 – hours same as above

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How can I assign a representative to act in my behalf?

You have the right to ask someone such as a family member or friend to help you with decisions about your health care. If you want to, you can use a special form to give someone the legal authority to make decisions for you if you ever become unable to make decisions for yourself. If you want to have an advance directive, you can get a form from your lawyer, from a social worker or from some office supply stores, or from other sources including the internet and advocacy groups. If you only wish to give the authority to represent you in dealings with Care1st for enrollment, claims and other administrative matters, you can download and complete the “Appointment of Representative”. Please note that copies of an advance directive, Appointment of Representative, or similar documents must be sent to Care1st to be effective for Care1st purposes.

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What can I do if I move out of your service area?

If you move out of the service area or are away from the service area for more than 6 months, you cannot remain a member of our Plan. Please call Member Services to find out if the place you are moving to or traveling to is in our Plan’s service area.

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MEDI-CAL


How can I join the Care1st Medi-Cal Program?

Enrollment for Care1st is processed by Health Care Options (HCO). You may contact them directly at 1-800-430-4263. HCO will mail you an enrollment packet that you will need to fill out and mail back to them. Once HCO receives your packet, it takes 15 to 45 days for you to become a member of Care1st.

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How can I obtain Specialty Services?

If you need care from a specialist, your PCP doctor must approve these services before you receive them.

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What should I do if I need Behavioral Services?

Behavioral Services are not a covered benefit under the Medi-Cal Program. If you need to obtain these services you may contact the toll-free numbers provided below.

Medi-Cal members who require behavioral health services can contact the Department of Mental Health’s Local 24 hour crisis line at:

Los Angeles: 1-800-854-7771
San Diego: 1-800-479-3339
The Department of Mental Health also has a suicide prevention hotline at 1-800-273-8255

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How can I get a new ID card, update my address, change my PCP or contact Member Services?

Contact Member Services. Our Member Service Department is available to assist you. Call us at 1-800-605-2556, Monday through Friday, 8:00 a.m. to 6:00 p.m. Our staff is comprised of Member Representatives that speak English, Spanish, Chinese, Armenian and Russian, and can answer any questions that you may have in regards to your health plan benefits. If you speak another language Care1st Health Plan can also assist you through the use of one of our translators.

Care1st ID Card. Call Member Services and they will issue you a new one. You should receive your new card within 7-10 business days.

PCP Change. As a member of Care1st, we want you to be comfortable with your assigned primary care doctor. Care1st has a large group of doctors for you to choose from. You may change your doctor by calling our Member Services Department at 1-800-605-2556. A change of doctor can be requested at any time, but it can take up to 30 days for the change to take effect.

Update Address. Call Care1st. We will update your address and instruct you to contact your eligibility worker at the DPSS toll-free number, 1-866-613-3777.

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I’m a new Care1st Medi-Cal member. When can I expect to receive my Welcome Packet?

When you become a member of Care1st Medi-Cal, you will receive a "Welcome Packet" within the first 7 days of eligibility. The "Welcome Packet" will include a welcome letter, Provider Directory, Evidence of Coverage, and your Care1st ID card.

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I understand Care1st offers transportation services, How can I arrange for a ride?

You are covered for transportation services to all routine, specialty, laboratory, and dental medical appointments. Some restrictions may apply. Please call Care 1st Transportation Department at 1-87RIDEC1ST (1-877-433-2178) from 8:00am – 5:00pm., Monday through Friday, at least 24 hours in advance.

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What should I do if I’m out of the Care1st coverage area and need emergency services?

If you have an emergency when you are not in our service area, you can obtain emergency services at the nearest emergency facility (doctor’s office, clinic or hospital). Emergency services do not require a referral or an okay from your PCP doctor.

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How do I obtain care after normal business hours?

It is important you always carry your Care1st ID card with you. If you think you have an emergency, call 911 or go to the nearest emergency room. If you need urgent care (when a condition, illness, or injury is not life threatening, but medical care is needed right away) call or go to your nearest urgent care center.

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What if I also qualify for Medicare benefits, and I already have my Medi-Cal benefits with Care1st? Who would be primary? Can I combine them?

If you are a Medi-Cal member and eligible for Medicare, it is important that you know that Medicare, not Medi-Cal, is your primary insurance. Care1st also offers Medicare coverage; if you are interested in combining your benefits please call Member Services for more information on the additional benefits available.

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What should I do if I receive a bill for covered services?

You should not receive a bill for any covered services. If you do, please call Member Services at:

  • 1-800-605-2556
    8 a.m. to 6 p.m., Monday through Friday

(TTY) 1-800-735-2929 – hours same as above

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How can I be sure my medical information is protected?

There are federal and state laws that protect the privacy of your medical records and personal health information. We protect your personal health information under these laws. Any personal health information that you give us when you enroll in this plan is protected. We will make sure that unauthorized people don’t see or change your records. If you have questions or concerns about privacy of your personal information and medical records, please call Member Services.

  • 1-800-605-2556
    8 a.m. to 6 p.m., Monday through Friday

(TTY) 1-800-735-2929 – hours same as above

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What benefits and services are not covered?

Some services are not covered by Care1st but are still benefits available through Med-Cal or another State program. Please call Member Services if you have any questions.
The following are non-covered services:

  • Acupuncture
  • Adult day health care
  • Alcohol and drug treatment services (outpatient)
  • Childhood lead poisoning
  • Chiropractic services
  • Mental Health Benefits

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What can I do if I move out of your service area?

If you move outside of Los Angeles County but still live in California, call your eligibility worker at DPSS right away toll free at 1-866-613-3777. Your eligibility worker can help you find out what Medi-Cal services are available in your new community.

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