Is this health insurance coverage?
No, SkyCare Direct is a primary care membership program. SkyCare Direct does not meet the criteria set forth by the Affordable Care Act to satisfy the individual mandate for insurance coverage.
Can I sign up if I already have insurance?
Yes. SkyCare Direct can work to complement existing insurance.
Can I sign up if I am enrolled in Medicaid, Medicare or Medicare Advantage?
No. At this time, enrollment in SkyCare Direct is not available to those individuals that currently receive Medicaid, Medicare or Medicare Advantage benefits.
I do not have insurance. What if something happens that is not on the list?
SkyCare Direct has arranged preferred pricing for services outside of the membership program. If an individual has difficulty in paying for these services, MetroHealth System’s benefits specialists will help review the individual’s situation to see if they qualify for additional financial assistance programs.
Does this take the place of signing up for ACA?
No. SkyCare Direct does not meet the criteria to satisfy the individual mandate. An individual that signs up for SkyCare Direct and has no other coverage is still subject to the IRS penalty for not having qualified insurance coverage.
If I cannot afford insurance, what are my options?
Below are several community resources to contact:
- MetroHealth Financial Counseling at 216-957-2325
- Carmella Rose Health Foundation at 216-658-6025
- For immediate needs: Call 211 or online 211oh.org
How are these services different from preventive services that are already covered with insurance?
Insurance plans are required by the Affordable Care Act to cover certain preventive services at no cost to the patient. In addition to many of these services, SkyCare Direct also covers primary care services that go beyond preventive care. For example, a member may need to be seen by their primary care provider for a sore throat. This visit would be covered within the SkyCare Direct program, however this would not be covered under at traditional insurance plan as a preventive service.
Can I sign up month to month?
While you can pay this membership monthly, SkyCare Direct requires an initial enrollment period of twelve (12) months.
Does this membership only cover services within the MetroHealth System?
Is there prescription coverage?
Yes Discount Drug Mart’s Generic Prescription Program includes hundreds of prescription and over-the-counter medications treating multiple conditions (such as diabetes, cholesterol, blood pressure, and much more) with SEVERAL as low as $1.99. No enrollment is necessary. To see the list, copy this link and paste it in your browser: https://discount-drugmart.com/pharmacy/generic-prescriptions/#all
Is there an income limit for this program?
Is there an age limit for this program?
I have a Health Savings Account. Can I pay for my membership with funds from the H.S.A.?
No. The IRS currently does not view primary care memberships as eligible medical expenses that are payable or reimbursable under a tax advantaged savings account such as a health savings account (HSA), medical savings account (MSA), flexible spending arrangement (FSA) or health reimbursement account (HRA).
Does this membership count toward my deductible?
Third-party payors may not count Membership Fees incurred pursuant to this Membership Agreement toward any deductible. Every plan is unique and the Patient should consult with his or her health benefits advisor regarding whether Membership Fees may be counted towards the Patient’s deductible under a high deductible plan.
How do I pay for this?
Payment for SkyCare Direct can be made in various ways, including cash, check, bank transfers, and most major credit cards. If you plan to pay with cash or paper check, please call 440-592-1122 to make arrangements.
Do I have to enroll online?
No, you can download a paper application and contract at this link
. You will need to call us for a price quote at 440-592-1122 to complete the application.