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2011 Medicare Advantage Plan Benefit Details for the Today's Options Premier 800 (PFFS) - H5421-049-0


2011 Medicare Advantage Plan Details
Medicare Plan Name:Today's Options Premier 800 (PFFS)
Location:Butts, Georgia
Plan ID:H5421 - 049 - 0     Click to see other plans
Member Services:1-866-568-8921 TTY users 1-800-958-2692
— This plan information is for research purposes only. —
Click here to see plans for the current plan year
— This plan was sanctioned in 2011 —
Medicare Contact Information:1-800-MEDICARE (1-800-633-4227)
TTY users 1-877-486-2048
Email a copy of the Today's Options Premier 800 (PFFS) benefit details
— Medicare Plan Features —
Monthly Premium:$60.00 (see Plan Premium Details below)
Annual Deductible:no drug coverage
Health Plan Type:PFFS *
Maximum Out-of-Pocket Limit for Parts A & B (MOOP):$6,700
Plan's Pharmacy Search:http://www.todaysoptions.com
Number of Members enrolled in this plan in (H5421 - 049):4,868 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
$60.00 monthly plan premium in addition to your monthly Medicare Part B premium.
Most people will pay the standard monthly Part B premium in addition to their MA plan premium. However some people will pay a higher premium because of their yearly income (over $85 000 for singles $170 000 for married couples). For more information about Part B premiums based on income call Medicare at 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048. You may also call Social Security at 1-800-772-1213. TTY users should call 1-800-325-0778.
This plan covers all Medicare-covered preventive services with zero cost sharing.
This plan does not allow providers to balance bill (charging more than your cost share amount).
$6 700 out-of-pocket limit.
This limit includes only Medicare-covered services.
** Doctor and Hospital Choice **
Doctor and Hospital Choice
You may go to any doctor specialist or hospital that accepts the plan's terms and conditions of payment.
** Extra Benefits **
Prescription Drugs
Most drugs not covered.
20% of the cost for Part B-covered chemotherapy drugs and other Part B-covered drugs.
This plan does not offer prescription drug coverage.
Physical Exams
$0 copay for routine exams.
Limited to 1 exam(s) every year.
Vision Services
  • $20 copay for one pair of eyeglasses or contact lenses after cataract surgery.
  • $0 to $20 copay for exams to diagnose and treat diseases and conditions of the eye.
  • $20 copay for up to 1 routine eye exam(s) every year
  • Dental Services
    $0 copay for Medicare-covered dental benefits.
    In general preventive dental benefits (such as cleaning) not covered.
    ** Important Information **
    Premium and Other Important Information
    $60.00 monthly plan premium in addition to your monthly Medicare Part B premium.
    Most people will pay the standard monthly Part B premium in addition to their MA plan premium. However some people will pay a higher premium because of their yearly income (over $85 000 for singles $170 000 for married couples). For more information about Part B premiums based on income call Medicare at 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048. You may also call Social Security at 1-800-772-1213. TTY users should call 1-800-325-0778.
    This plan covers all Medicare-covered preventive services with zero cost sharing.
    This plan does not allow providers to balance bill (charging more than your cost share amount).
    $6 700 out-of-pocket limit.
    This limit includes only Medicare-covered services.
    Doctor and Hospital Choice
    You may go to any doctor specialist or hospital that accepts the plan's terms and conditions of payment.
    ** Inpatient Care **
    Inpatient Hospital Care (Acute)
    You may go to any doctor specialist or hospital that accepts the plan's terms and conditions of payment except in emergencies.
    No limit to the number of days covered by the plan each benefit period.
    For Medicare-covered hospital stays:
    Days 1 - 6: $265 copay per day
    Days 7 - 90: $0 copay per day
    $0 copay for additional hospital days
    Inpatient Mental Health Care
    You get up to 190 days in a Psychiatric Hospital in a lifetime.
    For Medicare-covered hospital stays:
    Days 1 - 6: $265 copay per day
    Days 7 - 90: $0 copay per day
    Skilled Nursing Facility (SNF)
    Plan covers up to 100 days each benefit period
    No prior hospital stay is required.
    For SNF stays:
    Days 1 - 20: $0 copay per day
    Days 21 - 100: $135 copay per day
    Home Health Care
    0% of the cost for each Medicare-covered home health visit.
    Hospice
    You must get care from a Medicare-certified hospice.
    ** Outpatient Care **
    Doctor Office Visits
    You may go to any doctor specialist or hospital that accepts the plan's terms and conditions of payment.
    See 'Welcome to Medicare; and Annual Wellness Visit' for more information.
    $25 copay for each primary care doctor visit for Medicare-covered benefits.
    $50 copay for each specialist visit for Medicare-covered benefits.
    Chiropractic Services
    50% of the cost for each Medicare-covered visit.
    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
    $50 copay for each Medicare-covered visit.
    Medicare-covered podiatry benefits are for medically-necessary foot care.
    Outpatient Mental Health Care
    45% of the cost for each Medicare-covered individual or group therapy visit.
    Outpatient Substance Abuse Care
    45% of the cost for Medicare-covered individual or group visits.
    Outpatient Hospital Services
    $163 copay for each Medicare-covered ambulatory surgical center visit.
    $0 to $325 copay for each Medicare-covered outpatient hospital facility visit.
    Emergency Care
    $50 copay for Medicare-covered emergency room visits.
    $20 000 plan coverage limit for emergency services outside the U.S. every year.
    If you are admitted to the hospital within 24-hour(s) for the same condition you pay $0 for the emergency room visit
    Outpatient Rehabilitation Services
    There may be limits on physical therapy occupational therapy and speech and language pathology services. If so there may be exceptions to these limits.
    $45 copay for Medicare-covered Occupational Therapy visits.
    $45 copay for Medicare-covered Physical and/or Speech and Language Therapy visits.
    $45 copay for Medicare-covered Cardiac Rehab services.
    ** Outpatient Medical Services and Supplies **
    Durable Medical Equipment
    20% of the cost for Medicare-covered items.
    Prosthetic Devices
    20% of the cost for Medicare-covered items.
    Diabetes Self-Monitoring Training, Nutrition Therapy, and Supplies
    $0 copay for Diabetes self-monitoring training.
    $0 copay for Nutrition Therapy for Diabetes.
    0% to 20% of the cost for Diabetes supplies.
    ** Preventive Services **
    Bone Mass Measurement
    $0 copay for Medicare-covered bone mass measurement
    Colorectal Screening Exams
    $0 copay for Medicare-covered colorectal screenings.
    Immunizations
    $0 copay for Flu and Pneumonia vaccines.
    $0 copay for Hepatitis B vaccine.
    Pap Smears and Pelvic Exams
    $0 copay for Medicare-covered pap smears and pelvic exams.
    Prostate Cancer Screening Exams
    $0 copay for
    • Medicare-covered prostate cancer screening
    ** Additional Benefits **
    Dialysis
    $25 copay for renal dialysis
    $0 copay for Nutrition Therapy for End-Stage Renal Disease
    Prescription Drugs
    Most drugs not covered.
    20% of the cost for Part B-covered chemotherapy drugs and other Part B-covered drugs.
    This plan does not offer prescription drug coverage.
    Dental Services
    $0 copay for Medicare-covered dental benefits.
    In general preventive dental benefits (such as cleaning) not covered.
    Hearing Services
    Hearing aids not covered.
  • $20 copay for Medicare-covered diagnostic hearing exams
  • $20 copay for up to 1 routine hearing test(s) every year
  • Vision Services
  • $20 copay for one pair of eyeglasses or contact lenses after cataract surgery.
  • $0 to $20 copay for exams to diagnose and treat diseases and conditions of the eye.
  • $20 copay for up to 1 routine eye exam(s) every year
  • Physical Exams
    $0 copay for routine exams.
    Limited to 1 exam(s) every year.
    Health/Wellness Education
    The plan covers the following health/wellness education benefits:
  • Written health education materials including Newsletters
  • Nursing Hotline
  • Other Wellness 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
    This plan does not cover routine transportation.
    Acupuncture
    This plan does not cover Acupuncture.




    Tips & Disclaimers
    • The Medicare Advantage and Medicare Part D prescription drug plan data on our site comes directly from Medicare and is subject to change.
    • Medicare has neither reviewed nor endorsed the information on our site.
    • We provide our Q1Medicare.com site for educational purposes and strive to present unbiased and accurate information. However, Q1Medicare is not intended as a substitute for your lawyer, doctor, healthcare provider, financial advisor, or pharmacist. For more information on your Medicare coverage, please be sure to seek legal, medical, pharmaceutical, or financial advice from a licensed professional or telephone Medicare at 1-800-633-4227.
    • We are an independent education, research, and technology company. We are not affiliated with any Medicare plan, plan carrier, healthcare provider, or insurance company. We are not compensated for Medicare plan enrollments. We do not sell leads or share your personal information.
    • Benefits, formulary, pharmacy network, provider network, premium and/or co-payments/co-insurance may change on January 1 of each year. Our PDP-Compare.com and MA-Compare.com provide highlights of annual plan benefit changes.
    • The benefit information provided is a brief summary, not a complete description of benefits. For more information contact the plan.
    • Limitations, copayments, and restrictions may apply.
    • We make every effort to show all available Medicare Part D or Medicare Advantage plans in your service area. However, since our data is provided by Medicare, it is possible that this may not be a complete listing of plans available in your service area. For a complete listing please contact 1-800-MEDICARE (TTY users should call 1-877-486-2048), 24 hours a day/7 days a week or consult www.medicare.gov.
    • When enrolling in a Medicare Advantage plan, you must continue to pay your Medicare Part B premium.
    • Medicare beneficiaries with higher incomes may be required to pay both a Medicare Part B and Medicare Part D Income Related Monthly Adjustment Amount (IRMAA). Read more on IRMAA.
    • Medicare Advantage plans that include prescription drug coverage (MAPDs) are considered Medicare Part D plans and members with higher incomes may be subject to the Medicare Part D Income Related Monthly Adjustment Amount (IRMAA), just as members in stand-alone Part D plans. In certain situations, you can appeal IRMAA.
    • You must be enrolled in both Medicare Part A and Part B to enroll in a Medicare Advantage plan. Members may enroll in a Medicare Advantage plan only during specific times of the year. Contact the Medicare plan for more information.
    • If you are enrolled in a Medicare plan with Part D prescription drug coverage, you may be eligible for financial Extra Help to assist with the payment of your prescription drug premiums and drug purchases. To see if you qualify for Extra Help, call: 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048, 24 hours a day/ 7 days a week or consult www.medicare.gov; the Social Security Office at 1-800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday. TTY users should call, 1-800-325-0778; or your state Medicaid Office.
    • Medicare evaluates plans based on a 5-Star rating system. Star Ratings are calculated each year and may change from one year to the next.
    • A Medicare Advantage Private Fee-for-Service plan (PFFS) is not a Medicare supplement plan. Providers who do not contract with the plan are not required to see you except in an emergency.
    • Disclaimer for Institutional Special Needs Plan (SNP): This plan is available to anyone with Medicare who meets the Skilled Nursing Facility (SNF) level of care and resides in a nursing home.
    • Disclaimer for Dual Eligible (Medicare/Medicaid) Special Needs Plan (SNP): This plan is available to anyone who has both Medical Assistance from the State and Medicare. Premiums, co-pays, co-insurance, and deductibles may vary based on the level of Extra Help you receive. Please contact the plan for further details.
    • Disclaimer for Chronic Condition Special Needs Plan (SNP): This plan is available to anyone with Medicare who has been diagnosed with the plan specific Chronic Condition.
    • Medicare MSA Plans combine a high deductible Medicare Advantage Plan and a trust or custodial savings account (as defined and/or approved by the IRS). The plan deposits money from Medicare into the account. You can use this money to pay for your health care costs, but only Medicare-covered expenses count toward your deductible. The amount deposited is usually less than your deductible amount, so you generally have to pay out-of-pocket before your coverage begins.
    • Medicare MSA Plans do not cover prescription drugs. If you join a Medicare MSA Plan, you can also join any separate (stand-alone) Medicare Part D prescription drug plan
    • There are additional restrictions to join an MSA plan, and enrollment is generally for a full calendar year unless you meet certain exceptions. Those who disenroll during the calendar year will owe a portion of the account deposit back to the plan. Contact the plan provider for additional information.
    • Medicare beneficiaries may enroll through the CMS Medicare Online Enrollment Center located at www.medicare.gov.
    • Medicare beneficiaries can file a complaint with the Centers for Medicare & Medicaid Services by calling 1-800-MEDICARE 24 hours a day/7 days or using the medicare.gov site. Beneficiaries can appoint a representative by submitting CMS Form-1696.