TABLE OF CONTENTS

Can I use Plume if I have Medicaid?

Unfortunately, due to state laws, you cannot become a  Plume member if you have Medicaid in Colorado or Kentucky (even if you wanted to pay out of pocket for the membership). In these states, Medicaid has very strict billing rules that currently do not work with our membership model. For more information about your state’s restrictions, please contact your Medicaid program directly. In other states, you can become a Plume member if you have Medicaid, however you cannot use your insurance for membership fees. We hope to be able to accept Medicaid in the future and are working to make that an option.


Why can’t I use Medicaid to pay for my membership?

Plume is accepting some insurance policies at this time, but we are unable to accept Medicaid. Learn more about private insurance and Plume here.


Are all Plume providers credentialed by Medicaid?

No, not all of our providers at Plume are credentialed by Medicaid. Medicaid enrollment is the choice of individual providers, and some may be unable or choose not to register with Medicaid for various reasons.


How does it affect me if my provider is not credentialed by Medicaid?

If your provider is not credentialed by Medicaid, it can affect the cost of your prescriptions. Medicaid typically covers a significant portion of medication costs, so if your provider is not credentialed, you may need to use other payment options, such as GoodRx or other prescription coupons, to help manage costs.


What should I do if my provider is not credentialed by Medicaid?

If you find that your provider is not credentialed by Medicaid, we recommend using GoodRx or other prescription coupons to reduce the cost of your medications. GoodRx provides a list of pharmacies with different prices for your medication, and you can use a coupon to save on costs. You can print the coupon, email it to yourself, or screenshot it to show the pharmacy when you pay. GoodRx also has an app that is easy to navigate.


Why aren’t all Plume providers enrolled with Medicaid?

Medicaid enrollment is a personal decision for each provider and can be influenced by various factors. Some providers may face administrative challenges or have other reasons for not registering with Medicaid.


What happens if I move to a new provider who is not Medicaid credentialed?

Various factors such as moving to a new state or a provider no longer working with Plume may require some patients to be reassigned to new providers who are not Medicaid credentialed. If this happens, it may result in higher medication costs. Paying out of pocket and using GoodRx may be a cheaper alternative for you. 


Can Plume transfer me to another Medicaid-contracted provider?

We cannot guarantee that we will have an available Medicaid-contracted provider to transfer you to. If your only insurance option is Medicaid, you will need to pay out of pocket for your services with us. However, using GoodRx can help reduce your medication costs.


How can I find out if my provider is Medicaid credentialed?

You can inquire directly with your Care Team for assistance in verifying your provider's Medicaid status.


What should I do if I have more questions or need further support?

If you have any additional questions or need further support, please reach out to your Care Team in Spruce or at members@getplume.co. We are here to assist you with any concerns you may have.


Can I use Plume if I have Medicare?

Medicare has strict rules regarding how they cover outpatient services. This means that we cannot bill Medicare for monthly membership and all prescription costs. Patients who have Medicare may sign up for membership with Plume, but will be required to fill out a form acknowledging that costs associated with Plume (membership, labs, and medication) must be paid out of pocket. Medicare will not be billed for any costs associated with Plume. For new members, these documents will be available during intake. For current members, a Care Team member will reach out with the required documentation before your 65th birthday to continue care at Plume.