What is the difference between MyCare and Medicare benefits?
Access a list of covered benefits in this resource.
MyCare | Medicaid | |
Is Case Management available for my patient? | Yes | Yes |
Is my patient automatically enrolled in Case Management? | Yes | No |
Is CGM a covered benefit? | Yes | Yes |
Is Prior Auth required for CGM? | Yes* | No |
Is DSME a covered benefit? | Yes | Yes |
Is Non-Emergency Transportation a covered benefit? | Yes | Yes |
Is the pharmacy benefit managed by Single Pharmacy Benefit Manager (Gainwell)? | No | Yes |
Is the pharmacy benefit managed by the health plan? | Yes | No |
For Aetna, no prior authorization is required.
For CareSource, no prior authorization for Decom and FreeStyle through pharmacy benefit.
Access information for common CGM actions with MyCare patients >
Access information for common DSME actions with MyCare patients >