2011 Medicare Advantage Plan Details | |||||
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Medicare Plan Name: | POSITIVE HEALTHCARE PARTNERS (HMO SNP) | ||||
Location: | Broward, Florida Click to see other locations | ||||
Plan ID: | H3132 - 001 - 0 Click to see other plans | ||||
Member Services: | 1-888-456-4715 TTY users 711 | ||||
— This plan information is for research purposes only. — Click here to see plans for the current plan year | |||||
Medicare Contact Information: | Please go to Medicare.gov or call 1-800-MEDICARE (1-800-633-4227) to get information on all of your options. TTY users 1-877-486-2048 or contact your local SHIP for assistance |
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Email a copy of the POSITIVE HEALTHCARE PARTNERS (HMO SNP) benefit details | |||||
— Medicare Plan Features — | |||||
Monthly Premium: | $0.00 (see Plan Premium Details below) | ||||
Annual Deductible: | $310 | ||||
Annual Initial Coverage Limit (ICL): | $2,840 | ||||
Health Plan Type: | Local HMO | ||||
Special Needs Plan (SNP) Eligibility Requirement: | |||||
Additional Gap Coverage? | No additional gap coverage, only the Donut Hole Discount | ||||
Total Number of Formulary Drugs: | 2,619 drugs | Browse the POSITIVE HEALTHCARE PARTNERS (HMO SNP) Formulary | |||
This plan has drug tiers. See cost-sharing highlights below. | |||||
Formulary Drug Details: | Tier 1 | Tier 2 | Tier 3 | Tier 4 | Tier 5 |
• Preferred Pharmacy Cost-Sharing during initial coverage phase: | cost-sharing data not available. | ||||
• Number of Drugs per Tier: | |||||
Plan's Pharmacy Search: | http://www.positivehealthcare.org | ||||
Number of Members enrolled in this plan in (H3132 - 001): | 485 members | ||||
— Plan Premium Details — | |||||
Monthly Premium with Extra Help Low-Income Subsidy (LIS): ❔ | 100% Subsidy | 75% Subsidy | 50% Subsidy | 25% Subsidy | |
Monthly Part D Premium with LIS: | $0.00 | $0.00 | $0.00 | $0.00 | |
— Plan Health Benefits — | |||||
** Cost ** | |||||
Premium and Other Important Information | |||||
$0 monthly plan premium in addition to your monthly Medicare Part B premium. | |||||
This plan covers all Medicare-covered preventive services with zero cost sharing. | |||||
$0 out-of-pocket limit. | |||||
All plan services included. | |||||
** Doctor and Hospital Choice ** | |||||
Doctor and Hospital Choice | |||||
You must go to network doctors specialists and hospitals. | |||||
Referral required for network hospitals and specialists (for certain benefits). | |||||
** Extra Benefits ** | |||||
Prescription Drugs | |||||
$0 copay for Part B-covered drugs. | |||||
This plan uses a formulary. The plan will send you the formulary. You can also see the formulary at www.catalystrx.com/www/MedicareD/index.jsp?src=ahf on the web. | |||||
Different out-of-pocket costs may apply for people who
| |||||
The plan offers national in-network prescription coverage (i.e. this would include 50 states and DC). This means that you will pay the same cost-sharing amount for your prescription drugs if you get them at an in-network pharmacy outside of the plan's service area (for instance when you travel). | |||||
Total yearly drug costs are the total drug costs paid by both you and the plan. | |||||
Some drugs have quantity limits. | |||||
Your provider must get prior authorization from POSITIVE HEALTHCARE PARTNERS (HMO SNP) for certain drugs. | |||||
You must go to certain pharmacies for a very limited number of drugs due to special handling provider coordination or patient education requirements that cannot be met by most pharmacies in your network. These drugs are listed on the plan's website formulary printed materials as well as on the Medicare Prescription Drug Plan Finder on Medicare.gov. | |||||
If the actual cost of a drug is less than the normal cost-sharing amount for that drug you will pay the actual cost not the higher cost-sharing amount. | |||||
$310 yearly deductible. | |||||
After you pay your yearly deductible you pay 25% until total yearly drug costs reach $2 840. | |||||
You can get drugs the following way(s): | |||||
You can get drugs the following way(s): | |||||
After your total yearly drug costs reach $2 840 you receive a discount on brand name drugs and pay 93% of the plan's costs for all generic drugs until your yearly out-of-pocket drug costs reach $4 550. | |||||
After your yearly out-of-pocket drug costs reach $ 4 550 you pay the greater of:
| |||||
Plan drugs may be covered in special circumstances for instance illness while traveling outside of the plan's service area where there is no network pharmacy. You may have to pay more than your normal cost-sharing amount if you get your drugs at an out-of-network pharmacy. In addition you will likely have to pay the pharmacy's full charge for the drug and submit documentation to receive reimbursement from POSITIVE HEALTHCARE PARTNERS (HMO SNP). | |||||
You can get drugs the following way: | |||||
After you pay your yearly deductible you will be reimbursed up to 75% of the actual cost for drugs purchased out-of-network until your total yearly drug costs reach $2 840. | |||||
You will be reimbursed up to 7% of the plan allowable cost for generic drugs purchased out-of-network until total yearly out-of-pocket drug costs reach $4 550. | |||||
You will be reimbursed up to the discounted price for brand name drugs purchased out-of-network until total yearly out-of-pocket drug costs reach $4 550. | |||||
After your yearly out-of-pocket drug costs reach $ 4 550 you will be reimbursed for drugs purchased out-of-network up to the full cost of the drug minus your cost share which is the greater of:
| |||||
Physical Exams | |||||
Authorization rules may apply. | |||||
$0 copay for routine exams. | |||||
Limited to 1 exam(s) every year. | |||||
Vision Services | |||||
$0 copay for diagnosis and treatment for diseases and conditions of the eye | |||||
$0 copay for
| |||||
$100 plan coverage limit for eye wear every year. | |||||
Plan offers additional vision benefits. | |||||
Dental Services | |||||
$0 copay for Medicare-covered dental benefits. | |||||
$0 copay for the following preventive dental benefits: | |||||
Plan offers additional comprehensive dental benefits. | |||||
$850 plan coverage limit for dental benefits every year. | |||||
** Important Information ** | |||||
Premium and Other Important Information | |||||
$0 monthly plan premium in addition to your monthly Medicare Part B premium. | |||||
This plan covers all Medicare-covered preventive services with zero cost sharing. | |||||
$0 out-of-pocket limit. | |||||
All plan services included. | |||||
Doctor and Hospital Choice | |||||
You must go to network doctors specialists and hospitals. | |||||
Referral required for network hospitals and specialists (for certain benefits). | |||||
** Inpatient Care ** | |||||
Inpatient Hospital Care (Acute) | |||||
Plan covers 90 days each benefit period. | |||||
$0 copay | |||||
Except in an emergency your doctor must tell the plan that you are going to be admitted to the hospital. | |||||
Inpatient Mental Health Care | |||||
You get up to 190 days in a Psychiatric Hospital in a lifetime. | |||||
$0 copay | |||||
Except in an emergency your doctor must tell the plan that you are going to be admitted to the hospital. | |||||
Skilled Nursing Facility (SNF) | |||||
Authorization rules may apply. | |||||
Plan covers up to 100 days each benefit period | |||||
No prior hospital stay is required. | |||||
$0 copay for SNF services | |||||
Home Health Care | |||||
Authorization rules may apply. | |||||
$0 copay for Medicare-covered home health visits. | |||||
Hospice | |||||
You must get care from a Medicare-certified hospice. | |||||
** Outpatient Care ** | |||||
Doctor Office Visits | |||||
See 'Welcome to Medicare; and Annual Wellness Visit' for more information. | |||||
Authorization rules may apply. | |||||
$0 copay for each primary care doctor visit for Medicare-covered benefits. | |||||
$0 copay for the cost of each in-area network urgent care Medicare-covered visit. | |||||
$0 copay for each specialist doctor visit for Medicare-covered benefits. | |||||
Chiropractic Services | |||||
$0 copay for Medicare-covered chiropractic visits. | |||||
Medicare-covered chiropractic visits are for manual manipulation of the spine to correct subluxation (a displacement or misalignment of a joint or body part) if you get it from a chiropractor or other qualified providers. | |||||
Podiatry Services | |||||
Authorization rules may apply. | |||||
$0 copay for Medicare-covered podiatry benefits. | |||||
Medicare-covered podiatry benefits are for medically-necessary foot care. | |||||
Outpatient Mental Health Care | |||||
$0 copay for Medicare-covered Mental Health visits. | |||||
Outpatient Substance Abuse Care | |||||
$0 copay for Medicare-covered visits. | |||||
Outpatient Hospital Services | |||||
Authorization rules may apply. | |||||
$0 copay for each Medicare-covered ambulatory surgical center visit. | |||||
$0 copay for each Medicare-covered outpatient hospital facility visit. | |||||
Emergency Care | |||||
$0 copay for Medicare-covered emergency room visits. | |||||
Not covered outside the U.S. except under limited circumstances. Contact the plan for more details. | |||||
Outpatient Rehabilitation Services | |||||
Authorization rules may apply. | |||||
$0 copay for Medicare-covered Occupational Therapy visits. | |||||
$0 copay for Medicare-covered Physical and/or Speech and Language Therapy visits. | |||||
$0 copay for Medicare-covered Cardiac Rehab services. | |||||
** Outpatient Medical Services and Supplies ** | |||||
Durable Medical Equipment | |||||
Authorization rules may apply. | |||||
$0 copay for Medicare-covered items. | |||||
Prosthetic Devices | |||||
Authorization rules may apply. | |||||
$0 copay for Medicare-covered items. | |||||
Diabetes Self-Monitoring Training, Nutrition Therapy, and Supplies | |||||
Authorization rules may apply. | |||||
$0 copay for Diabetes self-monitoring training. | |||||
$0 copay for Nutrition Therapy for Diabetes. | |||||
$0 copay for Diabetes supplies. | |||||
** Preventive Services ** | |||||
Bone Mass Measurement | |||||
Authorization rules may apply. | |||||
$0 copay for Medicare-covered bone mass measurement | |||||
Colorectal Screening Exams | |||||
Authorization rules may apply. | |||||
$0 copay for Medicare-covered colorectal screenings. | |||||
Immunizations | |||||
Authorization rules may apply. | |||||
$0 copay for Flu and Pneumonia vaccines. | |||||
$0 copay for Hepatitis B vaccine. | |||||
No referral needed for Flu and pneumonia vaccines. | |||||
Pap Smears and Pelvic Exams | |||||
Authorization rules may apply. | |||||
$0 copay for Medicare-covered pap smears and pelvic exams. | |||||
Prostate Cancer Screening Exams | |||||
Authorization rules may apply. | |||||
$0 copay for
| |||||
** Additional Benefits ** | |||||
Dialysis | |||||
Authorization rules may apply. | |||||
$0 copay for renal dialysis | |||||
$0 copay for Nutrition Therapy for End-Stage Renal Disease | |||||
Prescription Drugs | |||||
$0 copay for Part B-covered drugs. | |||||
This plan uses a formulary. The plan will send you the formulary. You can also see the formulary at www.catalystrx.com/www/MedicareD/index.jsp?src=ahf on the web. | |||||
Different out-of-pocket costs may apply for people who
| |||||
The plan offers national in-network prescription coverage (i.e. this would include 50 states and DC). This means that you will pay the same cost-sharing amount for your prescription drugs if you get them at an in-network pharmacy outside of the plan's service area (for instance when you travel). | |||||
Total yearly drug costs are the total drug costs paid by both you and the plan. | |||||
Some drugs have quantity limits. | |||||
Your provider must get prior authorization from POSITIVE HEALTHCARE PARTNERS (HMO SNP) for certain drugs. | |||||
You must go to certain pharmacies for a very limited number of drugs due to special handling provider coordination or patient education requirements that cannot be met by most pharmacies in your network. These drugs are listed on the plan's website formulary printed materials as well as on the Medicare Prescription Drug Plan Finder on Medicare.gov. | |||||
If the actual cost of a drug is less than the normal cost-sharing amount for that drug you will pay the actual cost not the higher cost-sharing amount. | |||||
$310 yearly deductible. | |||||
After you pay your yearly deductible you pay 25% until total yearly drug costs reach $2 840. | |||||
You can get drugs the following way(s): | |||||
You can get drugs the following way(s): | |||||
After your total yearly drug costs reach $2 840 you receive a discount on brand name drugs and pay 93% of the plan's costs for all generic drugs until your yearly out-of-pocket drug costs reach $4 550. | |||||
After your yearly out-of-pocket drug costs reach $ 4 550 you pay the greater of:
| |||||
Plan drugs may be covered in special circumstances for instance illness while traveling outside of the plan's service area where there is no network pharmacy. You may have to pay more than your normal cost-sharing amount if you get your drugs at an out-of-network pharmacy. In addition you will likely have to pay the pharmacy's full charge for the drug and submit documentation to receive reimbursement from POSITIVE HEALTHCARE PARTNERS (HMO SNP). | |||||
You can get drugs the following way: | |||||
After you pay your yearly deductible you will be reimbursed up to 75% of the actual cost for drugs purchased out-of-network until your total yearly drug costs reach $2 840. | |||||
You will be reimbursed up to 7% of the plan allowable cost for generic drugs purchased out-of-network until total yearly out-of-pocket drug costs reach $4 550. | |||||
You will be reimbursed up to the discounted price for brand name drugs purchased out-of-network until total yearly out-of-pocket drug costs reach $4 550. | |||||
After your yearly out-of-pocket drug costs reach $ 4 550 you will be reimbursed for drugs purchased out-of-network up to the full cost of the drug minus your cost share which is the greater of:
| |||||
Dental Services | |||||
$0 copay for Medicare-covered dental benefits. | |||||
$0 copay for the following preventive dental benefits: | |||||
Plan offers additional comprehensive dental benefits. | |||||
$850 plan coverage limit for dental benefits every year. | |||||
Hearing Services | |||||
Authorization rules may apply. | |||||
$0 copay for Medicare-covered diagnostic hearing exams | |||||
$0 copay for | |||||
$0 copay for up to 1 hearing aid(s) every year. | |||||
$400 plan coverage limit for hearing aids every year. | |||||
Vision Services | |||||
$0 copay for diagnosis and treatment for diseases and conditions of the eye | |||||
$0 copay for
| |||||
$100 plan coverage limit for eye wear every year. | |||||
Plan offers additional vision benefits. | |||||
Physical Exams | |||||
Authorization rules may apply. | |||||
$0 copay for routine exams. | |||||
Limited to 1 exam(s) every year. | |||||
Health/Wellness Education | |||||
The plan covers the following health/wellness education benefits: | |||||
$0 copay for each Medicare-covered smoking cessation counseling session. | |||||
$0 copay for each Medicare-covered HIV screening. | |||||
HIV screening is covered for people with Medicare who are pregnant and people at increased risk for the infection including anyone who asks for the test. Medicare covers this test once every 12 months or up to three times during a pregnancy. | |||||
Transportation | |||||
Authorization rules may apply. | |||||
$0 copay for up to 12 round trip(s) to plan-approved location every year. | |||||
Acupuncture | |||||
This plan does not cover Acupuncture. |