q1medicare.com
Powered by Q1Group LLC
A non-government resource for the Medicare community
Powered by Q1Group LLC
A non-government Medicare community resource
  • Menu ☰
  • Home
  • Contact
  • MAPD
  • PDP
  • 2024
  • 2025
  • FAQs
  • Articles
  • Search ⌕
  • Contact
  • 2024
  • 2025
  • FAQs
  • Articles
  • Latest Medicare News
  • Search ⌕

2013 Medicare Advantage Plan Benefit Details for the Day Light (HMO)
This is archive material for research purposes. Please see PDPFinder.com or MAFinder.com for current plans.

2013 Medicare Advantage Plan Details
Medicare Plan Name:Day Light (HMO)
Location:Miami-Dade, Florida 33142     Click to see other locations
Plan ID:H4199 - 004 - 0     Click to see other plans
Member Services:1-866-988-2210 TTY users 1-866-988-2210
— 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
Email a copy of the Day Light (HMO) benefit details
— Medicare Plan Features —
Monthly Premium:$0.00 (see Plan Premium Details below)
Annual Deductible:no drug coverage
Health Plan Type:Local HMO *
Maximum Out-of-Pocket Limit for Parts A & B (MOOP):$3,400
Number of Members enrolled in this plan in (H4199 - 004):less than 10 members
Plan’s Summary Star Rating: New plan - No summary rating as of yet.
• Customer Service Rating: 3 out of 5 Stars.
• Member Experience Rating: Insufficient data to rate this plan.
• Drug Cost Accuracy Rating: Insufficient data to rate this plan.
— 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
$0.00 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.
FLORIDA HEALTHCARE PLUS will reduce your monthly Medicare Part B premium by up to $ 99.90.
$3 400 out-of-pocket limit for Medicare-covered services.
** 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 **
Over-the-Counter Items
Please visit our plan website to see our list of covered Over-the-Counter items. OTC items may be purchased only for the enrollee. Please contact the plan for specific instructions for using this benefit.
Transportation
Authorization rules may apply.
$0 copay for each one-way trip to plan-approved location.
** Important Information **
Premium and Other Important Information
$0.00 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.
FLORIDA HEALTHCARE PLUS will reduce your monthly Medicare Part B premium by up to $ 99.90.
$3 400 out-of-pocket limit for Medicare-covered services.
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
No limit to the number of days covered by the plan each hospital stay.
$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 of inpatient psychiatric hospital care in a lifetime. Inpatient psychiatric hospital services count toward the 190-day lifetime limitation only if certain conditions are met. This limitation does not apply to inpatient psychiatric services furnished in a general hospital.
$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. Your plan will pay for a consultative visit before you select hospice.
** Outpatient Care **
Doctor Office Visits
$0 copay for each Medicare-covered primary care doctor visit.
$0 copay for each Medicare-covered specialist visit.
Chiropractic Services
$0 copay for: Medicare-covered chiropractic visits
up to 12 supplemental routine chiropractic visit(s) every year
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.
Podiatry Services
$0 copay for Medicare-covered podiatry visits
up to 12 supplemental routine podiatry visit(s) every year
Medicare-covered podiatry visits are for medically-necessary foot care.
Outpatient Mental Health Care
Authorization rules may apply.
$0 copay for:
  • each Medicare-covered individual therapy visit
  • each Medicare-covered group therapy visit
    • $0 copay for:
    • each Medicare-covered individual therapy visit with a psychiatrist
  • each Medicare-covered group therapy visit with a psychiatrist
    • $0 copay for Medicare-covered partial hospitalization program services
    Outpatient Substance Abuse Care
    $0 copay for:
    • each Medicare-covered individual substance abuse outpatient treatment visit
  • each Medicare-covered group substance abuse outpatient treatment visit
    • Outpatient 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
    Ambulance Services
    $0 copay for Medicare-covered ambulance benefits.
    Emergency Care
    $50 copay for Medicare-covered emergency room visits
    $50 000 plan coverage limit for supplemental emergency services outside the U.S. and its territories 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.
    Urgently Needed Care
    $0 copay for Medicare-covered urgently-needed-care visits
    Outpatient Rehabilitation Services
    Authorization rules may apply.
    $0 copay for Medicare-covered Occupational Therapy visits
    $0 copay for Medicare-covered Physical Therapy and/or Speech and Language Pathology visits
    ** Outpatient Medical Services and Supplies **
    Durable Medical Equipment
    Authorization rules may apply.
    $0 copay for Medicare-covered durable medical equipment
    Prosthetic Devices
    Authorization rules may apply.
    $0 copay for Medicare-covered prosthetic devices
    Diabetes Programs and Supplies
    $0 copay for Medicare-covered Diabetes self-management training
    $0 copay for Medicare-covered:
    • Diabetes monitoring supplies
  • Therapeutic shoes or inserts
    • Diagnostic Tests, X-Rays, Lab Services, and Radiology Services
    Authorization rules may apply.
    $0 copay for Medicare-covered:
    • lab services
  • diagnostic procedures and tests
  • X-rays
  • diagnostic radiology services (not including X-rays)
  • therapeutic radiology services
    • ** Preventive Services **
    Cardiac and Pulmonary Rehabilitation Services
    Authorization rules may apply.
    $0 copay for:
    • Medicare-covered Cardiac Rehabilitation Services
  • Medicare-covered Intensive Cardiac Rehabilitation Services
  • Medicare-covered Pulmonary Rehabilitation Services
    • Preventive Services and Wellness/Education Programs
    Authorization rules may apply.
    $0 copay for all preventive services covered under Original Medicare at zero cost sharing. Any additional preventive services approved by Medicare mid-year will be covered by the plan or by Original Medicare.
    The plan covers the following supplemental education/wellness programs:
    • Health Education
  • Additional Smoking and Tobacco Use Cessation Visits
  • Health Club Membership/Fitness Classes
    • Kidney Disease and Conditions
    Authorization rules may apply.
    $0 copay for Medicare-covered renal dialysis
    20% of the cost for Medicare-covered kidney disease education services
    Outpatient Prescription Drugs
    Most drugs not covered.
    20% of the cost for Medicare Part B chemotherapy drugs and other Part B drugs.
    This plan does not offer prescription drug coverage.
    Dental Services
    $0 copay for Medicare-covered dental benefits
    $0 copay for the following preventive dental benefits:
    • up to 1 oral exam(s) every six months
  • up to 1 cleaning(s) every six months
  • up to 1 fluoride treatment(s) every six months
  • up to 1 dental x-ray(s) every year
    • Plan offers additional comprehensive dental benefits.
    Hearing Services
    $0 copay for Medicare-covered diagnostic hearing exams
    $0 copay for :
    • supplemental routine hearing exams
  • fitting-evaluations for a hearing aid
    • $0 copay for hearing aids.
    $1 000 plan coverage limit for hearing aids every year.
    ** Additional Benefits **
    Vision Services
    $0 copay for Medicare-covered diagnosis and treatment for diseases and conditions of the eye
    $0 copay for up to 2 supplemental routine eye exam(s) every year
    $0 copay for
    • one pair of Medicare-covered eyeglasses or contact lenses after cataract surgery
    • up to 2 pair(s) of glasses every year
  • up to 1 pair(s) of contacts every year
    • $500 plan coverage limit for eye wear every year.
    Over-the-Counter Items
    Please visit our plan website to see our list of covered Over-the-Counter items. OTC items may be purchased only for the enrollee. Please contact the plan for specific instructions for using this benefit.
    Transportation
    Authorization rules may apply.
    $0 copay for each one-way trip to plan-approved location.
    Acupuncture
    Authorization rules may apply.
    $0 copay per acupuncture visit.
    ** Inpatient Care **
    Inpatient Hospital Care
    No limit to the number of days covered by the plan each hospital stay.
    $0 copay
    Except in an emergency your doctor must tell the plan that you are going to be admitted to the hospital.
    ** Outpatient Care **
    Doctor Office Visits
    $0 copay for each Medicare-covered primary care doctor visit.
    $0 copay for each Medicare-covered specialist visit.
    Outpatient 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
    Ambulance Services
    $0 copay for Medicare-covered ambulance benefits.
    ** Outpatient Medical Services and Supplies **
    Durable Medical Equipment
    Authorization rules may apply.
    $0 copay for Medicare-covered durable medical equipment
    Diagnostic Tests, X-Rays, Lab Services, and Radiology Services
    Authorization rules may apply.
    $0 copay for Medicare-covered:
    • lab services
  • diagnostic procedures and tests
  • X-rays
  • diagnostic radiology services (not including X-rays)
  • therapeutic radiology services
    • ** Additional Benefits **
    Over-the-Counter Items
    Please visit our plan website to see our list of covered Over-the-Counter items. OTC items may be purchased only for the enrollee. Please contact the plan for specific instructions for using this benefit.
    Transportation
    Authorization rules may apply.
    $0 copay for each one-way trip to plan-approved location.




    Medicare Supplements
    fill the gaps in your
    Original Medicare
    1. Enter Your ZIP Code:
    » Medicare Supplement FAQs





    Ask a Pharmacist*
    Have questions about your medication?

    » Answers to Your Medication Questions, Free!
    Available Monday - Friday
    8am to 5pm MST
    *A free service included with your no cost drug discount card.


    © Q1Group LLC 2005 - 2024  



    Tips & Disclaimers
    • Q1Medicare®, Q1Rx®, and Q1Group® are registered Service Marks of Q1Group LLC and may not be used in any advertising, publicity, or for commercial purposes without the express authorization of Q1Group.
    • 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 PDPCompare.com and MACompare.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.
      Statement required by Medicare:
      "We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options."
    • 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.
    .