EOCCO Benefits for members 64+
Skip to main content

Benefits get better with age

Soon, you will turn 65. This means you may qualify for Medicare and other coverage, as well as your EOCCO plan. You may also transfer from Medicaid to Medicare.

Read on to learn more about Medicare and to see what your EOCCO plan covers. You may also qualify for premium payment assistance programs. Contact us to find out. We’re here to answer your questions.

We are here to guide you and answer any questions you may have about your health plan so you can get the care your child needs.

What is Medicare?

Medicare is the federal health insurance program. You may qualify for Medicare if1:

  • You are 65 or older
  • You are younger than 65 with certain disabilities
  • You have End-Stage Renal Disease (permanent kidney failure that requires dialysis or a transplant, sometimes called ESRD)

1 Find out if you qualify for Medicare.

What will your health plan cover?

See what medical and dental services your plan will cover.

Benefit type In-network coverage What you need to know
Medical
Primary care provider (PCP) Covered All EOCCO members have been assigned an in-network PCP or clinic.
Yearly checkups One visit per calendar year It is important to schedule a checkup every year. Your doctor will provide a physical exam and talk about important topics. Topics include healthy eating, exercise, preventive shots, safe sex, how to manage stress and more.
Women's annual exam Covered This is an annual exam and family planning visit.
Immunizations (shots) Covered You do not need a referral. You can get these from your doctor or any network provider.
Emergency room Covered An emergency is a condition that puts your life in danger. Call 911 or go to the emergency room when you think you are in danger.
Urgent care Covered This is care that you need the same day. You may need this kind of care for serious pain, an injury or illness, or to avoid losing function in part of your body. You do not need an appointment.
Specialist Covered You will need a referral from your PCP before seeing a specialist.
Hospital Covered You will need prior authorization (pre-approval) for hospital stays. Your doctor will get this approval. You do not need pre-approval for emergencies.
Labs, tests, X-rays Covered These are covered if your doctor orders them. Other authorized specialists may also order them.
Vision
Exam Limited coverage EOCCO does not cover routine vision exams. Please call customer service for more information.
Glasses and contact lenses Limited coverage EOCCO does not cover glasses/contacts. Please call customer service for more information.
Hearing
Hearing test Covered If you are needing hearing services, your doctor will make a referral.
Hearing aids Covered If you are needing hearing services, your doctor will make a referral.
Behavioral health
Outpatient Mental health assessments, group therapy and therapy Covered You can access help for any mental health services. No referral is needed.
Intensive care coordination Covered You can refer yourself for care coordination services, or someone can refer you. No referral or preapproval required.
Substance use treatment Covered You can get substance use disorder (SUD) services without a referral.

Inpatient SUD, residential and detox services need preapproval.
Assertive Community Treatment Covered Must be at least 18 years old and meet ACT criteria.
Specialty Services such as Neuropsych and Psychological Evaluations Covered These evaluations need to be prior authorized and meet medical necessity and / or medical appropriateness
Dental
Preventive care Covered This includes exams, cleanings, fluoride, varnish and X-rays.
Restorative care Covered This includes treatment for cavities and other problems such as fillings, tooth removal, crowns and dentures.
Specialist care Covered You may need a referral to see a specialist. Please ask your dentist before you schedule a specialist appointment.
Orthodonia (braces) Not covered Braces are not covered unless you need them to treat cleft palate.
Urgent and immediate treatment Covered These are dental conditions that do not require emergency room care. Examples include toothache, swollen gums and lost fillings.
Emergency dental care Covered 24 hours, 7 days a week. In a dental emergency, call your dentist day or night.
Pharmacy
Prescription medications Covered These are medications that a PCP, specialist or other provider prescribes. You can get your prescriptions at any in-network pharmacy. A list of these pharmacies is in the provider directory.
Get more pharmacy-related information
Screenings
Mammogram (breast X-ray) Covered Preventive care
Prostate screening Covered Preventive care
Colorectal screening Covered Preventive care
Drug and alcohol screening Covered Behavioral health
Depression screening and follow-up plan Covered Behavioral health

Coverage by age

View benefits and coverage for other age groups.

Questions?

Customer Service: 888-788-9821 (TTY users: 711)
Pharmacy Customer Service 888-474-8539
Hours: Monday through Friday, 7:30 a.m. to 5:30 p.m. PST

EOCCO members should have their member ID number ready for quicker help.

See more options