Samaritan Advantage Members’ Frequently Asked Questions

Thank you for choosing Samaritan Health Plans! We are working hard to ensure you have all the information you need to get the most out of your benefits.

Check back to see our progress as we add more information to this page. We will add more questions and answers as they are received.

Would like to print these questions and answers? Download a copy (updated Feb. 20, 12:45 p.m.).
If you do not have a printer, contact Customer Service at 541-768-4550 or toll free at 800-832-4580
(TTY 800-735-2900) and a copy can be mailed to you.

Frequently Asked Questions

Q: Are eye exams and glasses covered, including those that are medically necessary?

A. Yes. We cover one routine eye exam per calendar year. Medicare-covered medical eye exams (to diagnose or treat diseases and injuries of the eye) are covered as often as needed. A preventive glaucoma screening is also covered at no cost. Your provider should bill all eye exams directly to the Samaritan Health Plans.
There is no cost for one pair of Medicare-covered eyeglasses (standard frame and lenses) following cataract surgery. Samaritan Health Plans should be billed directly for this service. All plans also have an annual allowance for routine vision hardware (eyeglasses, frames, lenses, contacts and upgrades). Use your Benefits MasterCard to pay for routine vision hardware, up to the annual allowance covered by your plan.

Q. Are routine vaccines covered for Valor members without Part D coverage?

A. Valor members are still able to get vaccines that are covered through Medicare Part B. Examples of vaccines covered under Part B are:

  • Flu shots, once each flu season in the fall and winter, with additional flu shots if medically necessary.
  • Hepatitis B vaccine if you are at high or intermediate risk of getting Hepatitis B.
  • COVID-19 vaccine.
  • Pneumonia vaccine.
  • Other vaccines if you are at risk and they meet Medicare Part B coverage rules.

Q. How does the Annual Wellness Visit work and do I need to wait 12 months to schedule one?

A. If you have been eligible for Medicare longer than 12 months, then you don’t need to wait to schedule an Annual Wellness exam. The Annual Wellness Visit, annual physical exam or Welcome to Medicare Visit (each covered once per calendar year) are all free benefits for plan members. Members who complete one of these visits will receive $25 on their Rewards & Incentives Mastercard. For more information, please visit samhealthplans.org/Rewards-and-Incentives.

Q: How is international travel covered by my plan?

A: The plan will only cover in the event of an emergency when services are received in an emergency room. This does not include emergent drugs or transportation.

Q: What does the dental plan cover, and how do I use my Benefits Mastercard for dental services?

A: The dental benefit covers preventive services such as cleanings, exams and X-rays as well as comprehensive and restorative services such as crowns, fillings, root canals, bridges, dentures, etc. The only service not covered is orthodontia. Simply use your Benefits MasterCard like a credit card to swipe and pay for services, up to the annual allowance covered by your plan.

Q: What medical alert solutions does Samaritan offer and how can I learn more?

A: Samaritan Advantage Health Plans offer a Personal Emergency Response Service, or PERS. Find out more by visiting your Advantage benefits page at samhealthplans.org/AdvantageBenefits or by calling our service provider, Medical Guardian at 800-914-5531.

Q: Do I need a referral to see a pulmonary specialist?

A: You do not need to submit a referral to the plan. The pulmonary specialist may require a referral from your primary care or other provider.

Q: Do I need a referral to see a specialist?

A: Some specialists may require a referral from a primary care provider or other physician of choice before they will see you. Contact your primary care provider if you feel you need the care of a specialist and they can assist you with that referral. Samaritan Advantage does not require referrals to be submitted to the plan.

Q: How can I check to see if my current health care providers are covered by Samaritan Health Plans?

A: You can access the Samaritan Advantage provider directory at samhealthplans.org/Find-a-Provider. If you have any questions, please call Customer Service at 541-768-4550 or toll free at 800-832-4580
(TTY 800-735-2900). Hours are 8 a.m. to 8 p.m. daily, Oct. 1 through March 31, and 8 a.m. to 8 p.m. Monday through Friday, April 1 through Sept. 30.

Q: How does the acquisition of the Corvallis Clinic by Optum affect those who have Corvallis Clinic doctors?

A: The good news is that as of right now, there is really no impact. Corvallis Clinic is part of our health plan network. Just like it was before. It may take a long time for that acquisition to be fully finalized, if indeed it does get finalized. It has to go through a lot of review with regulators. What we do know is that in the Seattle area, Optum acquired several other clinics like the Everett Clinic and the Polyclinic several years ago. What’s actually played out in that market is that there has been very little, if any, impact on other health plan provider networks. Optum is maintaining all of its relationships with other health plans and some of the concerns that were in the Seattle community that maybe Optum would freeze out other health plans besides United Healthcare have not played out. We are optimistic that the impact on our community will be very limited, if any.

Q: I was assigned a new PCP but I want to stay with my current provider. What should I do?

A:  If you were assigned a new PCP but want to stay with your current primary care provider in our network, please call Customer Service at 541-768-4550 or toll free at 800-832-4580 (TTY 800-735-2900) to get your PCP updated to the one you currently see. 

Q: We seem to have been assigned a new PCP and dentist that we did not request. Why is that?

A: There was a glitch in our system that incorrectly assigned several PCPs. You are not required to tell us who your PCP is, but if you would like to update the information, you can contact Customer Service at 541-768-4550 or toll free at 800-832-4580 (TTY 800-735-2900). Hours are 8 a.m. to 8 p.m. daily, Oct. 1 through March 31, and 8 a.m. to 8 p.m. Monday through Friday, April 1 through Sept. 30.

Q: How can I use the Silver&Fit card? Can I go to multiple fitness locations or am I limited to just one?

A: The Silver&Fit fitness benefit offers a fitness center benefit and a home fitness kit benefit. Members have access to hundreds of participating fitness center locations and can switch between locations as they wish. There is also an option to order one home fitness kit per year. Silver&Fit is included with the Premier Plan Plus premium
and available for a nominal additional fee with the Premier and Valor plans.
Go to silverandfit.com to sign up or call 877-427-4788, Monday through Friday 5 a.m. to 6 p.m.

Q: When will the SamFit in north Albany open again?

A: This location is planning to reopen soon, but an exact date has not been determined. You can follow all the news about SamFit at facebook.com/BeMoreThanFit.

Q: If I am in a provider’s office, sick and a medication is prescribed, do I need to check the formulary before having the provider call the prescription into the pharmacy?

A: You can certainly check the formulary and see if it is a covered medication or you can have your provider check and see if it is covered. If they send it to the pharmacy and it is not covered, the pharmacy will tell you at that point that this is not covered. The pharmacy will reach out to your provider to initiate a prior authorization. Your provider can also look it up or you can always call Samaritan Health Plans Customer Service and we can look it up for you. Also, for more urgent prescriptions, for things like antibiotics, those should not have prior authorization criteria. However, per the Centers for Medicare and Medicaid Services, we can’t cover any cough medications or anything over-the-counter.

Q: What is the process for changing pharmacies?

A: To find a network pharmacy, you can look in your pharmacy directory on the Samaritan Health Plans website at samhealthplans.org/Find-a-Drug or contact Customer Service at 541-768-4550 or toll free at 800-832-4580 (TTY 800-735-2900).

You will want to call the pharmacy that you want to switch to, let them know where your prescriptions currently are being held and the pharmacies will handle that internally within themselves. If you want to go from one Safeway to another, that’s usually pretty easy. You call the Safeway you want to go to and they can transfer your prescriptions. If you want to switch from a Safeway to a Samaritan pharmacy, it’s also an easy process but usually takes a little bit more time because the pharmacies have to talk to each other and transfer the prescriptions.

Q. How can I provide feedback on the user design of the provider directory or request changes to the benefits coverage?

A. Please contact our Customer Service Department with any questions or concerns at 541-768-4550 or 800-832-4580 (TTY 800-735-2900).

Q: How do you transfer your medical records from your previous provider to your new one? What is the procedure?

A: The process may be a bit different depending on which provider. A member who is using for example, Corvallis Clinic as a new patient, the procedure might be a little different than if they were going to Samaritan Medical Group as a new patient. It’s best to contact your physician’s office for assistance.

Q. How do I access services like transportation for medical procedures?

A. To schedule a ride to any health-related location, call Cascade West Ride Line at 866-724-2975 (TTY 711). Hours of operation are Monday through Friday 8 a.m. to 5 p.m.

Q: Is there an Office of Patient Advocacy at Samaritan and how can I contact them?

A: Yes, you can email Patient Advocacy at shswebcontactus-general@samhealth.org or visit the Samaritan Health Services website at samhealth.org/Contact-Us and fill out the form for Patient Advocacy (comments or complaints).

Q: Will there be ongoing town hall meetings to discuss plan concerns?

A: We will continue to monitor our members’ questions and concerns. We will update our website if any new town hall dates are added and send out a postcard to announce any new events.

Q: Can I use my OTC quarterly benefit to purchase CPAP supplies?

A: No. That should be covered under the DME benefit through the plan. So, you shouldn’t need to use your OTC dollars for that and those wouldn’t be covered as part of that over-the-counter benefit.

Q: Can over-the-counter, or OTC drugs and supplements be purchased with my Benefits Mastercard and are they eligible for reimbursement?

A: OTC items can be bought at most pharmacies, stores or online stores that take MasterCard. Some common stores in your area are Bi-Mart, Walmart, Fred Meyer and Rite Aid. You can visit Cardholders (sig-is.org) to find a store near you. For more information, review the list of covered OTC drugs online by going to samhealthplans.org/BenefitsMastercard or call Customer Service at 541-768-4550 or 800-832-4580 (TTY 800-735-2900).

Q: How can I check balance on my Benefits Mastercard?

A: Login to the MyHealthPlan portal at the top of the samhealthplans.org homepage. Once inside the portal, click on Benefits Card login to view your balance. You can also check your balance 24/7 by calling 888-831-4668.

Q. How do I determine which items are eligible for purchase with the Benefits Card?

A: A list of eligible OTC items that can be purchased at retail stores, pharmacies and online merchants can be found at samhealthplans.org/BenefitsMastercard. This is not a comprehensive list, but rather a list of categories and examples of common items. Unfortunately, we are not able to provide a list that is more detailed than this.

Q. How do I use my Benefits MasterCard for over-the-counter items, dental and vision expenses?

A. Instead of paying out of pocket, Samaritan Advantage provides you with a way to pay for some of your qualified health care expenses, such as over-the-counter items and certain dental, vision and hearing benefits. Your prepaid Benefits Mastercard is loaded with the value of these supplemental benefits, according to the plan you have.

Q: How does Samaritan Advantage decide which OTC items are eligible?

A: We follow the Center for Medicare and Medicaid, also known as CMS, guidelines for what is and is not eligible to be covered by the OTC benefit. We have an OTC list that has categories of items that are considered eligible, dual purpose and ineligible. Each category has examples of items that are most likely to pay in the retail setting. You can also choose to use our online catalog. There you will find items available that our vendor has been able to source for you and you can order through this online option. Order online at samaritanOTC.com.

Q: I went to a local Walgreens and bought a series of products marked as OTC-eligible but at checkout, only one was covered. Why?

A: The items that Walgreen has tagged as being OTC-eligible are more for a flexible spending account program that people would have through a commercial insurer or their employer’s insurance. Most of those items are not necessarily ones that are covered as a Medicare over-the-counter benefit. Also, some brand items work better when making retail purchases because of the technology behind the card. Generic items tend to not be as consistent because a store may not have updated its system to indicate that this generic item is eligible. We are working with our card vendor and looking for ways to improve that experience for you in the future.

Q: If I try and buy something by accident that really isn’t covered on my Benefits Mastercard, will the charge be rejected?

A: It depends on the location and what you are buying. There are measures in place to prevent non-covered items from being purchased under the OTC benefit. When paying for dental, vision and hearing aid services, there are not as many protections. For example, if your vision provider were to include the copay for an exam when charging your card, the card would not know that it shouldn’t be used for the exam copay.

Q: If I buy an OTC item at a retail store, is the price the same as the OTC catalog?

A: To our knowledge, there isn’t a price difference.

Q: Is the Benefits Mastercard a debit card or a credit card?

A: Your Benefits Mastercard does work as a credit card. You do have an option to select a pin if you would like one to use it as debit, but you certainly don’t have to. If you do want to have a pin for your card, you have to request that through the portal yourself. For security purposes, there is no way for us to request a pin for you and share it with you. Please note: Nobody should know your PIN other than you.

Q: What if I use a different product of an item than is in the catalog? For example, my eye doctor recommends Refresh Advanced Eye Solution, but the card only allows Refresh Tears. Can this be changed?

A: Yes. The list of examples is not meant to be all inclusive. If it is in the same kind of category of an item that is covered, then it would still be a covered item.

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Page Updated 2-26-2024

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