“Health Choices” Plans
This is a group of similar but separate health care plans paid with federal/state taxpayer funds. Large health care insurance carriers operate these plans. The program is called Health Choices because patients have the right to choose between one of three insurance programs.
There are three plans available in the Lehigh/Capital Zone, but throughout the state, there are currently seven, which include: AmeriHealth Mercy, Gateway, Unison, Health Partners, AmeriChoice, UPMC and Keystone Mercy.
You need to make this choice based on what best serves the needs of you and your child. You have the right to change insurance companies/plans when you wish, but this will take some time and effort.
Health Choices companies are responsible to develop a “network” or group of physicians and dentists to treat their enrollees or members. Understand that each company handles situations somewhat differently and can treat each dentist differently. Because of this, not all MA providers participate in all the Health Choices plans. You should ask your Health Choices company representative which dentists are on their provider list prior to selecting any plan. It might be helpful to contact a few of the dentists on this list for advice regarding which plan to use.
The “Access” or “Access
Access and Access Plus are the MA insurance plans developed, managed and operated by the Department of Public Welfare (DPW) and do not involve any private insurance companies. These programs only involve MA patients. Dental coverage is based on the age of the patient. For patients up to age 21, all medically necessary dental care is to be provided. For patients ages 21 and older, dental coverage is more limited. Covered services, deductibles, co-pays and limitations are determined entirely by the government.
For dental care, it provides specific fees for many procedures, which you or your child may need. However, obtaining what DPW considers a “special service” will require preauthorization or approval from DPW. Fees paid to dentists cannot be negotiated. Some dentists who accept some of the MA plans do not accept the “Access” plan.
To find a dentist who participates with your state insurance plan, go to www.insurekidsnow.gov. By clicking on various links on this website, you can learn more about MA and CHIP programs.
Here is a list of MA plans: