Medicare & Medicaid plan provider manages care and serves Western New Yorkers with a variety of health needs
Kalos Health commemorated its fifth anniversary of managing health care for Western New Yorkers with a reception and ribbon cutting with the Niagara USA Chamber on Wednesday, July 17.
Kalos Health is a regional nonprofit health insurance organization specializing in Medicaid Managed Long-Term Care (MLTC) and Medicare Dual Advantage Plans that collaborates with health care providers to improve the quality of life for Western New Yorkers.
Kalos Health Vice President Kathleen Velasquez and Niagara USA Chamber Executive Director Kory Schuler introduced elected officials and health care industry partners and discussed the recent achievements of the organization.
Founded in 2014, Kalos (Greek for noble or good) Health coordinates health care services through a vast network of medical providers designed to meet the medical needs of the diverse populations it serves. The organization began operating with an MLTC plan for Medicaid recipients who have chronic health conditions, and then expanded its scope in 2018 to include an HMO-Special Needs Plan, called Kalos Health Gold Plus, designed specifically for members with Medicare Part A & B who also have full New York state Medicaid benefits.
Through these two health insurance plans, Kalos Health educates and empowers members across a variety of communities to maintain a healthy lifestyle that supports their personal goals. Cross-functional staff guide members through the enrollment process and coverage options while ensuring they have access to quality care from providers, specialists and preventive services when and where they need it.
“Our focus is always on improving the quality of life for our members as they are challenged by a variety of health conditions and symptoms that need managing and extra support,” said Velasquez. “The ultimate goal is to preserve the independence of our members and support them as they live in nursing homes or remain in their homes for as long as possible. We are dedicated to delivering thorough, personalized care and counsel for each member’s unique circumstances, and we are proud of our trusted network of medical providers that collaborate with us to elevate the wellness and peace of mind for Western New Yorkers of all ages.”
The Kalos Health Gold Plus plan was created in 2018 to support people who received Medicaid and Medicare to ensure they maximize their benefits and receive more personalized care. Members must be 21 years of age and older, live in Erie, Niagara, Orleans or Cattaraugus counties, have Medicare Part A and Part B and full New York state Medicaid benefits. Kalos Health Gold Plus works with each member to create a personalized care plan to remain healthy and active and reduce unnecessary hospitalizations. The plan has no monthly premium and features free preventive care while providing everything that Medicare and Medicaid cover. It also offers prescription drug coverage and a $900 annual over-the-counter benefit card.
The Gold Plus care plan includes the member’s chosen team of doctors and provides a licensed Medicare advisor, master social worker, registered nurse for case management, licensed practical nurse for care coordination, and a nurse practitioner for plan members in nursing homes. This multi-disciplinary team fulfills enrollment, assists in coordinating appointments and transportation and helps manage symptoms and conditions.
The MLTC plan provides experienced registered nurse care managers that develop a comprehensive team of professionals to provide access to care 24 hours a day, seven days a week. Plan members must be 18 years and older, live in Erie, Niagara, Monroe, Chautauqua, Genesee or Orleans counties, be covered by or eligible for Medicaid, living in nursing homes or able to live safely at home with assistance for daily living activities and require home- and community-based services in excess of 120 days a year for nursing care, therapies and related personal assistant services.
“I like that Kalos Health is independent and not a conglomerate, and they provide better personal service. They keep in touch with me every month. I always hear from them, and that’s very important to me. They go above and beyond what other insurance companies do. They check in to see if you need other services and never wait for you to call with needs,” said Laura Dubois, a charter member of the Kalos Health MLTC plan since July 2014.
For member eligibility, contact Kalos Health at 1-800-399-1954 (TTY: 711) 8 a.m.-8 p.m. Monday through Friday (April 1-Sept. 30). From 8 a.m.-8 p.m. Oct. 1 through March 31, member services is available seven days a week.
For more information, visit KalosHealth.org.