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This is archive material for research purposes. Please see PDPFinder.com or MAFinder.com for current plans.

2011 AB Basic Plan (Cost) in San Juan, Colorado

Medicare Advantage Plan Benefit Details in Plain Text
The following Medicare Advantage plan benefits apply to the AB Basic Plan (Cost) (H0602 - 026) in San Juan, Colorado .

This plan is administered by .  To switch to a different Medicare Advantage plan or to change your location, click here.
Click here to see the AB Basic Plan (Cost) health benefit details in chart format or email and view benefits chart

Plan Premium
The AB Basic Plan (Cost) has a monthly premium of $25.00. That is $300.00 for 12 months. There are a few factors that can increase or decrease this premium. If you qualify for full or partial extra help, your premium will be lower. If you have a premium penalty, your premium will be higher. Please remember that the $25.00 montly premium is in addition to your Medicare Part B premium. If you have a premium penalty, your premium will be higher. Or if you have a higher income you would be subject to the Income Related Adjustment Amount (IRMAA).

This Medicare Advantage Plan without Prescription Drug Coverage is a Cost * plan.

Please be aware that this plan does NOT include Prescription Drug Coverage!
The AB Basic Plan (Cost) offers many Health Coverage Benefits. The following section will describe these benefits in detail.

** Cost **
Premium and Other Important Information
$25.00 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 does not cover all Medicare-covered preventive services with zero cost sharing.
** Doctor and Hospital Choice **
Doctor and Hospital Choice
No referral required for network doctors specialists and hospitals.
You can use any network doctor. If you go to out-of-network doctors the plan may not cover the services but Medicare will pay its share for Medicare-covered services. When Medicare pays its share you pay the Medicare Part B deductible and coinsurance.
** 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
When you get Medicare Part B you can get a one-time physical within the first 12 months of your new Part B coverage. The coverage does not include lab tests.
20% of the cost for the required Medicare-covered initial preventive physical exam and annual wellness visits.
Vision Services
Non-Medicare-covered eye exams and glasses not covered.
$0 copay for
  • one pair of eyeglasses or contact lenses after cataract surgery
  • 20% of the cost for exams to diagnose and treat diseases and conditions of the eye.
    • Dental Services
    Authorization rules may apply.
    In general preventive dental benefits (such as cleaning) not covered.
    20% of the cost for Medicare-covered dental benefits.
    ** Important Information **
    Premium and Other Important Information
    $25.00 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 does not cover all Medicare-covered preventive services with zero cost sharing.
    Doctor and Hospital Choice
    No referral required for network doctors specialists and hospitals.
    You can use any network doctor. If you go to out-of-network doctors the plan may not cover the services but Medicare will pay its share for Medicare-covered services. When Medicare pays its share you pay the Medicare Part B deductible and coinsurance.
    ** Inpatient Care **
    Inpatient Hospital Care (Acute)
    Plan covers 90 days each benefit period.
    You will not be charged additional cost sharing for professional services.
    Inpatient Mental Health Care
    You get up to 190 days in a Psychiatric Hospital in a lifetime.
    Same deductible and copay as inpatient hospital care (see 'Inpatient Hospital Care')
    Skilled Nursing Facility (SNF)
    Plan covers up to 100 days each benefit period
    You will not be charged additional cost sharing for professional services.
    Home Health Care
    $0 copay for Medicare-covered home health visits.
    Hospice
    You must get care from a Medicare-certified hospice.
    ** Outpatient Care **
    Doctor Office Visits
    20% of the cost for each primary care doctor visit for Medicare-covered benefits.
    20% of the cost for each in-area network urgent care Medicare-covered visit.
    20% of the cost for each specialist visit for Medicare-covered benefits.
    Chiropractic Services
    20% 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
    20% of the cost for each Medicare-covered visit.
    Medicare-covered podiatry benefits are for medically-necessary foot care.
    Outpatient Mental Health Care
    Authorization rules may apply.
    45% of the cost for each Medicare-covered individual or group therapy visit.
    20% of the cost for each Medicare-covered individual or group therapy visit with a psychiatrist.
    Outpatient Substance Abuse Care
    Authorization rules may apply.
    20% of the cost for Medicare-covered individual or group visits.
    Outpatient Hospital Services
    Authorization rules may apply.
    20% of the cost for each Medicare-covered ambulatory surgical center visit.
    20% of the cost for each Medicare-covered outpatient hospital facility visit.
    Emergency Care
    20% of the cost for Medicare-covered emergency room visits.
    Not covered outside the U.S. except under limited circumstances. Contact the plan for more details.
    If you are admitted to the hospital within 3-day(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.
    20% of the cost for Medicare-covered Occupational Therapy visits.
    20% of the cost for Medicare-covered Physical and/or Speech and Language Therapy visits.
    20% of the cost for Medicare-covered Cardiac Rehab services.
    ** Outpatient Medical Services and Supplies **
    Durable Medical Equipment
    Authorization rules may apply.
    20% of the cost for Medicare-covered items.
    Prosthetic Devices
    Authorization rules may apply.
    20% of the cost for Medicare-covered items.
    Diabetes Self-Monitoring Training, Nutrition Therapy, and Supplies
    20% of the cost for Diabetes self-monitoring training.
    20% of the cost for Nutrition Therapy for Diabetes.
    20% of the cost for Diabetes supplies.
    ** Preventive Services **
    Bone Mass Measurement
    20% of the cost for Medicare-covered bone mass measurement.
    Colorectal Screening Exams
    20% of the cost for Medicare-covered colorectal screenings.
    Immunizations
    $0 copay for Flu and Pneumonia vaccines.
    No referral needed for Flu and pneumonia vaccines.
    20% of the cost for Hepatitis B vaccine.
    Pap Smears and Pelvic Exams
    0% of the cost for Medicare-covered pap smears.
    20% of the cost for Medicare-covered pelvic exams.
    Prostate Cancer Screening Exams
    20% of the cost for Medicare-covered prostate cancer screening.
    ** Additional Benefits **
    Dialysis
    Cost plan members pay Fee-for-Service cost sharing for out-of-area dialysis.
    20% of the cost for renal dialysis
    20% of the cost 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
    Authorization rules may apply.
    In general preventive dental benefits (such as cleaning) not covered.
    20% of the cost for Medicare-covered dental benefits.
    Hearing Services
    In general routine hearing exams and hearing aids not covered.
  • 20% of the cost for Medicare-covered diagnostic hearing exams
    • Vision Services
    Non-Medicare-covered eye exams and glasses not covered.
    $0 copay for
    • one pair of eyeglasses or contact lenses after cataract surgery
  • 20% of the cost for exams to diagnose and treat diseases and conditions of the eye.
    • Physical Exams
    When you get Medicare Part B you can get a one-time physical within the first 12 months of your new Part B coverage. The coverage does not include lab tests.
    20% of the cost for the required Medicare-covered initial preventive physical exam and annual wellness visits.
    Health/Wellness Education
    The plan covers the following health/wellness education benefits:
  • Written health education materials including Newsletters
    • $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.




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