HMOs Which Assume Responsibility for Medicare Coverage COMPANY
Cigna-HealthSpring Preferred (HMO)
Humana Community Plan HMO H-2649-031
United HealthCare AARP MedicareComplete (HMO)
Premium or Subscription Charges
$0 monthly plan premium. Cigna contracts with Medicare to provide full Medicare coverage plus additional benefits.
$0
No monthly premium. Medicare Complete contracts with Medicare to provide full Medicare coverage plus additional benefits. Member must continue to pay Part B premium.
Registration or Policy Fee
N/A
$0
None
Pre-existing Health Conditions
Not available for patients with end-stage renal (kidney) disease.
Not available for those with end-stage renal (kidney)disease unless already a health plan member.
Individuals with end stage renal (kidney) disease is not eligible
Costs on Entry to Hospital
$180/day: days 1-7: $0/day: days 8-90
$280 days 1-7 $0 days 8-90
Member has a total out of pocket maximum for all copays except pharmacy and physician. The copay for hospital is $275 days 1-7 counted toward a out of pocket maximum of $2,800.
Maximum Period of Coverage for Any One Benefit
Unlimited- 365 days in a calendar year. Medicare beneficiaries may only receive 190 days in a psychiatric hospital in a lifetime.
Hospital - Unlimited number of authorized, medically necessary days. Other limitations may apply for other benefits.
Benefits are based on the calendar year and are covered 365 days of the year.
Skilled Nursing Facility
$0/day: days 1-20: $167/day: days 21-100
$0 days 1-20 - $167.50 days 21-100
$0.00 days 1-20/ $160.00 days 21-38/ $0.00 days 39-100
Medical Coverage for Part B
Members must continue to pay Medicare Part B premium.
Members must continue to pay Part B premium to Medicare
Covered in full after applicable copayments/coinsurance. In-patient services by physicians are covered at no cost.
Physician care for hospital or office services, surgery, anesthesia, X-ray, laboratory, injections, splints, casts, dressings, physical and speech therapy, radiology, ambulance, prosthetics, etc.
Physician care for Hospital or Office services: In PCP office $0: In Specialist office $25, Physical therapy and Speech therapy $25, Home Health $0, Lab services in Physician’s office $0: HospOP/ASC facility $20, X-ray services $0, Prosthetics 20%, Ambulatory Surgical Center (ASC) $150, Ambulance Ground $200, Ambulance Air $200, Radiation therapy 20%, MRI, CT, PET: ASC/HospOP $200; 20% for nuclear medicine studies.
$0 PCP office visit - $30 Specialist office visit - $0 - $50 labs at in network labs - Ambulance $265 - MD Live Telemedicine $10 per encounter - XRAY $0-$150 - Hearing aid Benefit - $699 Flyte 700 $999 Flyte 900.
$0 for Preventative Services. $0 for PCP and $35 for specialist visits. Radiology $7-20%, Lab service is $2. DME, Prosthetics, and Part B drugs are 20% coinsurance. O/P Hospital and O/Ps surgery $250. Ambulance $250. ER $80, waived if admitted. Copays and coinsurance count toward the out of pocket max of $2800.
Outpatient Prescription Drugs
One Month Supply: Tier 1 (Preferred Generic) $2, Tier 2 (Generic Drugs) $10, Tier 3 (Preferred Brand Drugs) $42, Tier 4 (Non-Preferred Drugs) $95, Tier 5 (Specialty) 33%
Preferred Mail Order $0 for 90 day supply Tiers 1 and 2 - 30 day supply Tier 3 $47, Tier 4 $100, Tier 5 33%
$0 deductible on all Tiers .Tier 1 $3 copay. Tier 2 $12 copay. Tier 3 $45 copay. Tier 4 $95 copay. Tier 5 33%. No coverage after $3750 until out of pocket costs equal to $5000. Then 5 percent or $3.35 for Generic and Preferred Brand, All other 5% or $8.35.
Renewability of Contract
Medicare Advantage contracts are renewable annually
Good for all of 2018
Guaranteed renewable for life.
Travel Restrictions Out of Area
Urgent care ($0)and emergency care ($100) services are available to you when you are out of area. You are covered 24 hours a day, seven days a week.
ER and Urgent Care Only
Worldwide coverage for emergency and urgent care with a $80 copay (waived if admitted to hospital). Routine & preventive care is covered out of residence county w/Passport Benefit.
Major Options Available from Company
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.
Silver Sneakers included - Over the Counter Allowance $75/Qtr MOOP of $4,900 and transportation has been added - 12 one-way or 6 round trip.
Plan covers Optum Fitness fitness program, dental exams and cleanings, routine eye exam and routine podiatry visits. Hearing Aid package. Dental rider is available. Large Network of providers.
A.M. Best Rating
4.5 out of 5 Star Rating
A-
A
For More Information
1-855-561-3811(TTY 711) 7 days a week, 8am-8pm. Hours apply Monday-Friday February 15-September 30.
602-760-1700
1-800-547-5514 TTY 711
Outpatient Care
You must live in Pima County
www.LovinLifeAfter50.com
Pima County and Partial Pinal
Available in Pima County
NOVEMBER 2017 |
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