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 >