|Are some bills too big or too small for CAREAssist to cover?|
CAREAssist will pay your part of the cost no matter how small or large the amount is, up to the annual maximum benefit for your group. See your Summary of CAREAssist Benefits for information on your maximum benefit.
|Can CAREAssist help a member with medical visit copays and deductibles?|
Yes. CAREAssist membership means you get help paying for doctor's office visits, lab tests, and any other insurance-covered services. A deductible usually happens at the beginning of the year and then copays follow that. Group 1 members can get up to $5,000 of assistance per year. Group 3 members can get up to $2,500 per year.
|Can I access medications while on vacation?|
Maybe. In most cases, you can obtain a vacation supply of medications PRIOR to leaving on vacation. This must be authorized by your insurance provider and NOT CAREAssist. CAREAssist will not make copayments to any out-of-state pharmacy without prior agreement, so make sure you have enough medication before going out of town.
If you're going out of town for more than a month, and have concerns about paying your cost-share or returning your Client Eligibility Review (CER), please call your CAREAssist caseworker.
|Can the doctor or lab bill CAREAssist directly?|
Yes. The doctor or lab directly billing CAREAssist is the best way. Show your medical provider's billing staff your CAREAssist member card and tell them that CAREAssist is acting as a "secondary payer."
The address for mailing claims to CAREAssist is on the back of your member card. It is best to check occasionally with the billing staff to make sure that they still have CAREAssist listed as your "secondary payer."
|Do clients have to use mail-order?|
Most clients who are uncomfortable using a mail order pharmacy will not be required to do so.
|Do I have to pay a fee to be enrolled in CAREAssist?|
Clients with income that exceeds roughly $1436 per month for a household of 1 will be billed a monthly cost-share. Your cost-share will be 2% of your average gross monthly income as calculated by CAREAssist. Your household number along with your income is what determines if you have a cost share.
|How can I get more involved with CAREAssist?|
There are a number of ways you can become involved in CAREAssist and make your voice heard.
Join the CAREAssist Advisory Committee: As a member of CAREAssist, we welcome you to take part in the CAREAssist Advisory Committee. The CAREAssist Advisory Committee is an official task force of the Oregon HIV Care Coalition. The purpose of the group is to provide input and direction to the program related to CAREAssist client eligibility, program design and implementation. Meetings are held quarterly and are open to the public. More information about the CAREAssist Advisory Committee is available on this website or ask your CAREAssist caseworker.
CAREAssist conducts regular surveys to see how we're doing and to help us understand where we could improve our services. We welcome your responses, so please fill out and return any surveys that are mailed to you.
Join us at Prevent HIV Oregon on Facebook or Twitter!
|How does CAREAssist define "family"?|
CAREAssist uses the federal definition of household to describe persons that live with you. By household, they really mean fmaily or persons who are legally related to you. Here are some examples of how we calculate your family size (for purposes of definition, spouse refers to a person to whom you are legally married and partner refers to someone with whom there is not a legal marriage):
- You and your partner (not legally married), no children = household of 1.
- You, your legal spouse, and 1 child under 18 = household of 3
- You, your child from a previous relationship, and your partner (not legally married) = household of 2
- If you and your partner (not legally married) have a biological child together = household of 3
|How does CAREAssist get billed for my pharmacy copay?|
First, you will need to talk with your CAREAssist caseworker to set up the pharmacy from the CAREAssist network of approved pharmacies where you want to pick up your prescriptions (not all pharmacies will bill CAREAssist). Once this is completed, you will need to inform the pharmacy that it will need to bill CAREAssist for your medication copay and you will need to present your CAREAssist membership card to them.
If you have any problems with this or if the pharmacy has questions, please contact your CAREAssist caseworker.
|What are the advantages of using the mail-order pharmacy?|
It may be more convenient to have them mailed to you. Many health care programs have been providing this service to its clients for many years. It may be more confidential for our clients.
|What do I do if I'm moving out of Oregon?|
If you spend more than 3 consecutive months outside of Oregon (with the exception of fully enrolled students), you are not eligible for CAREAssist (Oregon's AIDS Drug Assistance Program or ADAP). If you move permanently to another state outside of Oregon, you may be eligible for ADAP services in another state. All states in the U.S. have ADAP, although ADAP programs vary from state to state. Here is where you can find information related to ADAP and HIV-related services in other states:www.atdn.org/access/ or call 1-800-734-7104, Extension 2.
|What if I am an Oregon resident but I want to attend school out of state?|
Students who attend an out-of-state school are eligible for CAREAssist as long as they maintain their residency in Oregon. Documentation of current enrollment in an educational institution is required. For purposes of income eligibility, student loans are not considered income.
|What if I can't pay my Cost-share this month?|
Failure to pay your cost-share can result in your CAREAssist benefits being restricted or even terminated. If you can't pay please contact your CAREAssist worker to see if you are eligible for a cost-share adjustment and discuss payment arrangements.
|What if I go to jail or prison?|
All correctional facilities are mandated to provide health care services to inmates. Because CAREAssist is funded by the Ryan White Program, we are the payer of last resort. That means if there is someone else who will pay for your health care, they have to pay it. Because of this rule, you may be terminated from CAREAssist if you become incarcerated, particularly if you go to prison. If you have been in jail for longer than 3 months, you should call CAREAssist to re-establish your CAREAssist membership upon release.
|What if I paid for my copay myself? Will CAREAssist pay me back?|
CAREAssist is unable to make payments directly to a client. In the event that you have paid a copay, deductible or premium out of your own pocket, you will not be reimbursed. To avoid this, make sure you provide your CAREAssist card to your doctor or pharmacist every time you receive a service or pick up a prescription.
|What if the doctor or lab bill is sent to me?|
Start saving the reports your insurance company sends you after each time your insurance is billed. These reports are called "Explanation of Benefits" or EOBs (Blue Cross calls them Claims Processing Reports). Keep all your EOBs in one place and save them for at least 6 months. It's a good idea to do this whether or not you ever have to send CAREAssist a bill.
If you get a bill from the lab or doctor, after your insurance has paid, it usually means CAREAssist did not pay that bill. If you want CAREAssist to pay, quickly send the bill and the EOB that matches both the date and the amount owed. If we do not get both the provider bill and the matching EOB, it will be sent back to you. We do not have the ability to track partial paperwork. Remember, the address to mail CAREAssist your claims is on the back of your member card.
|What income should I report when applying or recertifying for the program?|
Income is defined as any monies you and your household members consistently receive that are used to meet your basic needs. This includes, but is not limited to work income, unemployment benefits, SSI/SSDI, regular gifts from family/friends, self-employment income, payments from a trust or retirement account, etc. Please note that failure to report income can result in termination from the CAREAssist program for up to a year. If you are unsure what is may be considered as income, please call CAREAssist.
|What is CAREAssist?|
CAREAssist is the name for Oregon's AIDS Drug Assistance Program. These programs provide access to HIV medications to eligible clients, are available in all states and are funded by a combination of state and federal dollars. CAREAssist is part of the Oregon Health Authority HIV Care and Treatment program.
|What is the deadline for submitting a bill to CAREAssist to cover?|
Bills must be submitted within 12 months from the date of service and you must have been a CAREAssist member at the time the service occurred.
|What is the income limit for CAREAssist?|
When first applying to the program, the maximum gross monthly income is roughly $2873 for a household of 1. Once enrolled, clients can make up to approximately $3351, again for a household of 1.
|Where do I send Cost-Share payments?|
Cost-share payments should be mailed to PO Box 14260, Portland OR 972193-0260. Add the CAREAssist ID number to the memo line on your check or money order. You will also want to make sure that the clients name is indicated some place on the check or money order. Use one check or money order per client. Do not use 1 payment method to pay multiple clients cost share.
|Will CAREAssist help me if I have to go to the emergency room while out of state?|
Maybe. You should check with your primary insurance provider to find out if they cover this. The general rule of thumb is that if your primary insurance provider pays for the service, then CAREAssist will help you.
|Will CAREAssist pay for any medical service my insurance covers?|
Yes. CAREAssist will pay your part of the cost as long as the service is approved by your insurance and the date of services is within the last 12 months. Sometimes that is a deductible amount that has to be paid before the insurance starts to pay. CAREAssist will pay that deductible if it is for a covered service. Typically, insurance pays 60% - 80% of the cost and then the doctor or lab service asks you for the rest. CAREAssist will pay your part, up to the maximum yearly amount noted above. Payments are made on all services, not just HIV-related care.