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HMOs That Assume Responsibility for Medicare Coverage Cigna-HealthSpring Preferred (HMO)
Blue Medicare Advantage Classic (HMO)
CareMore Touch (HMO SNP)
(Available in Maricopa County, Pima County and parts of Pinal County)
Maricopa County H2593-019
(Available in Maricopa county, and select Zip codes within Pinal County: 85117, 85118, 85119, 85120, 85140, 85143, 85178 and 85220)
Premium or Subscription Charges
$0 monthly premium
$0 monthly plan premium. Cigna contracts with Medicare to provide full Medicare coverage plus additional benefits.
Registration or Policy Fee
Must have Part A and Part B of Medicare, Live in the service area, must reside in a long-term care community or plan approved location and cannot have ESRD.
Pre-existing Health Conditions
Not available for patients with end-stage renal (kidney) disease and receiving dialysis.
Must not have ESRD
Not available for patients with end-stage renal (kidney) disease.
Costs on Entry to Hospital
$250 per day for days 1-7 in plan hospital; same cost sharing for non-plan hospital with prior authorization (different cost sharing applies to inpatient mental health).
Day 1-5 $175 copay Day 6-90 $0 copay
$200/day: days 1-7: $0/day: days 8-90
Maximum Period of Coverage for Any One Benefit
364 days in calendar year.
Out-of-pocket limit $3000
Unlimited- 365 days in a calendar year. Medicare beneficiaries may only receive 190 days in a psychiatric hospital in a lifetime.
Skilled Nursing Facility
$20 per day for days 1-10 in plan skilled nursing facility; $20 per day for days 11-20; $165 per day 21-100 in plan SNF; same cost sharing for non plan skilled nursing facility with prior authorization. No prior hospital stay required.
Each stay: $0 copay
$0/day: days 1-20: $167/day: days 21-100
Medical Coverage for Part B
$20 per day for days 11-20;
Members must continue to pay Medicare Part B premium.
$165 per day 21-100 in plan SNF;
$0 Copay for routine nurse practitioner visits / $0 copay for PCP / $0 Copay for specialist Laboratory:$0 copay / physical therapy: $0 copay / X-ray: $0 copay / $0 copay for routine podiatry every three months / $195 copay for ambulance $0 copay for DME if $499 or Less
Physician care for hospital or office services: In PCP office $0: In specialist office $30, Physical therapy and speech therapy $30, home health $0, lab services in physician’s office $0: HospOP/ASC facility $20, X-ray services $0, prosthetics 20 percent, ambulatory surgical center (ASC) $0 for colorectal, $0 for colonoscopy, and $150 all other ASC services ambulance ground $250, ambulance air $250, radiation therapy 20 person, MRI, CT, PET: $150 at CMG or contracted Facility. 20 person for nuclear medicine studies.
Outpatient Prescription Drugs
Same cost sharing for non-plan skilled nursing facility with prior authorization.
Tiers 1-6 : $0/$7.50/$40/$85/33%/$0 Network Pharmacy
One Month Supply: Tier 1 (preferred generic drugs) $2, Tier 2 (generic drugs) $10, Tier 3 (preferred brand drugs) $42, Tier 4 (non-preferred brand) $95, Tier 5 (specialty) 29 percent
Renewability of Contract
No prior hospital stay required.
Medicare Advantage contracts are renewable annually
Travel Restrictions Out of Area
Coverage throughout the United States for emergency and urgently needed care only.
$10,000 Coverage for Emergency and Urgent Care Worldwide
Urgent care ($25)and emergency care ($80) services are available to you when you are out of area. You are covered 24 hours a day, seven days a week.
Major Options Available from Company
Hearing Aids, Health/wellness education, disease management. Discounts on eyewear.
BASIC DENTAL COVERAGE INCLUDED. Quarterly $50 OTC benefit. Silver Sneakes $0 copay. On-site delivery of most healthcare services at member’s assisted living enviroment including routine nurse practitioner visits, quarterly primary care physician visits, quarterly routine podiatry visits, onsite labs, x-rays, physical therapy, occupational therapy, speech therapy, wound care and more. Transportation: 6 one-way trips to plan approved locations.Please call CareMore Health Plan for more information.
Plans offer hearing, vision, and chiropractic benefits. Dental option available for $20 monthly premium. Fitness Program- Basic gym membership at a participating fitness location including fitness classes. Provides home fitness kits as an alternative program option in lieu of facility membership.
A.M. Best Rating
Medicare STAR ratings released in October
4.5 out of 5 Star Rating
For More Information
For more information about all of Blue Cross Blue Shield of Arizona Advantage Plans or to register for a seminar please call 1-888-273-4093, TTY: 711, 8 a.m.–8 p.m. daily from Oct. 1 to Feb. 14. Hours from Feb. 15–Sept.30 are 8 a.m.-8 p.m. Monday–Friday.
1-855-561-3811 (TTY 711) 7 days a week, 8 a.m-8 p.m. Hours apply Monday-Friday Feb. 15-Sept. 30.
Outpatient Care Physician care for hospital or office services, surgery, anesthesia, X-ray, laboratory, injections, splints, casts, dressings, physical and speech therapy, radiology, ambulance, prosthetics, etc.
| NOVEMBER 2017
Published on Oct 31, 2017