Do I Qualify to Become a Member of Provider Partners Health Plan?
To learn if you (or your loved one) are likely to qualify for the services offered by Provider Partners Health Plans (PPHP), please answer the following questions. Our staff also is happy to help you determine your eligibility. Just contact our Member Services number at 1-800-405-9681 for additional information. (TTY users should call 711). We are open 8:00 A.M. to 8:00 P.M., seven days a week from October 1 through March 31; 8:00 A.M. to 8:00 P.M. Monday to Friday from April 1 through September 30.
- Have you been a resident of a nursing home or skilled nursing facility for longer than thirty (30) days? (Note: prospective beneficiaries in Westmoreland County PA do not need to meet this requirement.)
- Do you currently have Medicare Part A (hospital insurance) and Part B (medical insurance)?
- Do you qualify for Medicaid coverage as well as Medicare Parts A and B? If so, you also may be eligible to enroll.
Please note that if you have end stage renal disease and are on dialysis, you will not qualify for PPHP coverage.
You are eligible for membership in our plan as long as:
- You live in one of our network nursing homes in one of our service area:
- In Maryland in 2020, our service area includes Baltimore City and ten Maryland counties – Baltimore, Harford, Carroll, Howard, Frederick, Anne Arundel, Washington, Allegany, Garrett and Dorchester counties.
- In Pennsylvania in 2020, PPHP covers care in fourteen Pennsylvania counties – Philadelphia, Bucks, Butler, Armstrong, Montgomery, Westmoreland, Delaware, Chester, Lancaster, Lawrence and Mercer,Beaver, Fayette, and Washington counties.
- In Illinois in 2020, PPHP covers care in four Illinois counties – Cook, McHenry, Will, and Winnebago counties.
- In Ohio in 2020, PPHP covers care in six Ohio counties – Cuyahoga, Fairfield, Hocking, Lake, Stark, and Summit couties.
- You have both Medicare Part A and Medicare Part B,
- And you do not have End-Stage Renal Disease (ESRD), with limited exceptions, such as if you develop ESRD when you are already a member of a plan that we offer, or you were a member of a different plan that was terminated.