2013 Medicare Advantage Plan Details | |||||
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Medicare Plan Name: | Geisinger Gold Reserve (MSA) | ||||
Location: | McKean, Pennsylvania Click to see other locations | ||||
Plan ID: | H8468 - 001 - 0 Click to see other plans | ||||
Member Services: | 1-800-498-9731 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 Geisinger Gold Reserve (MSA) benefit details | |||||
— Medicare Plan Features — | |||||
Monthly Premium: | MSAs do not have a monthly premium. (see Plan Premium Details below) | ||||
Annual Deductible: | no drug coverage | ||||
Health Plan Type: | MSA * | ||||
Maximum Out-of-Pocket Limit for Parts A & B (MOOP): | $0 | ||||
Number of Members enrolled in this plan in (H8468 - 001): | 5,192 members | ||||
Plan’s Summary Star Rating: | Does not apply. | ||||
• Customer Service Rating: | Does not apply. | ||||
• Member Experience Rating: | Does not apply. | ||||
• Drug Cost Accuracy Rating: | Does not apply. | ||||
— 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 | |||||
Balance billing means that a provider may charge and bill you more than the plan’s payment amount for services There is a limit on what providers may charge for Medicare-covered services | |||||
You will not have a monthly plan premium. Medicare pays the monthly plan premium for the Medicare MSA Plan. | |||||
Most people will pay the standard monthly Part B 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. | |||||
Balance billing counts towards your plan deductible. | |||||
$3 000 annual deductible | |||||
Note that only Medicare-covered services will count toward your annual deductible. | |||||
Medicare will deposit $1 500 into your bank account. | |||||
** Extra Benefits ** | |||||
Over-the-Counter Items | |||||
The plan does not cover Over-the-Counter items. | |||||
Transportation | |||||
This plan does not cover supplemental routine transportation. | |||||
** Important Information ** | |||||
Premium and Other Important Information | |||||
Balance billing means that a provider may charge and bill you more than the plan’s payment amount for services There is a limit on what providers may charge for Medicare-covered services | |||||
You will not have a monthly plan premium. Medicare pays the monthly plan premium for the Medicare MSA Plan. | |||||
Most people will pay the standard monthly Part B 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. | |||||
Balance billing counts towards your plan deductible. | |||||
$3 000 annual deductible | |||||
Note that only Medicare-covered services will count toward your annual deductible. | |||||
Medicare will deposit $1 500 into your bank account. | |||||
** Inpatient Care ** | |||||
Inpatient Hospital Care | |||||
Once you reach the plan deductible Medicare MSA plans cover Original Medicare benefits. Co-pay for Medicare MSAs is $0 once deductible is met. | |||||
Inpatient Mental Health Care | |||||
Once you reach the plan deductible Medicare MSA plans cover Original Medicare benefits. Co-pay for Medicare MSAs is $0 once deductible is met. | |||||
Skilled Nursing Facility (SNF) | |||||
Once you reach the plan deductible Medicare MSA plans cover Original Medicare benefits. Co-pay for Medicare MSAs is $0 once deductible is met. | |||||
Home Health Care | |||||
Once you reach the plan deductible Medicare MSA plans cover Original Medicare benefits. Co-pay for Medicare MSAs is $0 once deductible is met. | |||||
Hospice | |||||
You must get care from a Medicare-certified hospice. Your plan will pay for a consultative visit before you select hospice. | |||||
Once you reach the plan deductible Medicare MSA plans cover Original Medicare benefits. Co-pay for Medicare MSAs is $0 once deductible is met. | |||||
** Outpatient Care ** | |||||
Doctor Office Visits | |||||
Once you reach the plan deductible Medicare MSA plans cover Original Medicare benefits. Co-pay for Medicare MSAs is $0 once deductible is met. | |||||
Chiropractic Services | |||||
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. | |||||
Once you reach the plan deductible Medicare MSA plans cover Original Medicare benefits. Co-pay for Medicare MSAs is $0 once deductible is met. | |||||
Podiatry Services | |||||
Medicare-covered podiatry visits are for medically-necessary foot care. | |||||
Once you reach the plan deductible Medicare MSA plans cover Original Medicare benefits. Co-pay for Medicare MSAs is $0 once deductible is met. | |||||
Outpatient Mental Health Care | |||||
Once you reach the plan deductible Medicare MSA plans cover Original Medicare benefits. Co-pay for Medicare MSAs is $0 once deductible is met. | |||||
Outpatient Substance Abuse Care | |||||
Once you reach the plan deductible Medicare MSA plans cover Original Medicare benefits. Co-pay for Medicare MSAs is $0 once deductible is met. | |||||
Outpatient Services | |||||
Once you reach the plan deductible Medicare MSA plans cover Original Medicare benefits. Co-pay for Medicare MSAs is $0 once deductible is met. | |||||
Ambulance Services | |||||
Once you reach the plan deductible Medicare MSA plans cover Original Medicare benefits. Co-pay for Medicare MSAs is $0 once deductible is met. | |||||
Emergency Care | |||||
Once you reach the plan deductible Medicare MSA plans cover Original Medicare benefits. Co-pay for Medicare MSAs is $0 once deductible is met. | |||||
Urgently Needed Care | |||||
Once you reach the plan deductible Medicare MSA plans cover Original Medicare benefits. Co-pay for Medicare MSAs is $0 once deductible is met. | |||||
Outpatient Rehabilitation Services | |||||
Once you reach the plan deductible Medicare MSA plans cover Original Medicare benefits. Co-pay for Medicare MSAs is $0 once deductible is met. | |||||
** Outpatient Medical Services and Supplies ** | |||||
Durable Medical Equipment | |||||
Once you reach the plan deductible Medicare MSA plans cover Original Medicare benefits. Co-pay for Medicare MSAs is $0 once deductible is met. | |||||
Prosthetic Devices | |||||
Once you reach the plan deductible Medicare MSA plans cover Original Medicare benefits. Co-pay for Medicare MSAs is $0 once deductible is met. | |||||
Diabetes Programs and Supplies | |||||
Once you reach the plan deductible Medicare MSA plans cover Original Medicare benefits. Co-pay for Medicare MSAs is $0 once deductible is met. | |||||
Diagnostic Tests, X-Rays, Lab Services, and Radiology Services | |||||
Once you reach the plan deductible Medicare MSA plans cover Original Medicare benefits. Co-pay for Medicare MSAs is $0 once deductible is met. | |||||
** Preventive Services ** | |||||
Cardiac and Pulmonary Rehabilitation Services | |||||
Once you reach the plan deductible Medicare MSA plans cover Original Medicare benefits. Co-pay for Medicare MSAs is $0 once deductible is met. | |||||
Preventive Services and Wellness/Education Programs | |||||
This plan does not cover supplemental education/wellness programs. | |||||
Once you reach the plan deductible Medicare MSA plans cover Original Medicare benefits. Co-pay for Medicare MSAs is $0 once deductible is met. | |||||
Kidney Disease and Conditions | |||||
Once you reach the plan deductible Medicare MSA plans cover Original Medicare benefits. Co-pay for Medicare MSAs is $0 once deductible is met. | |||||
Outpatient Prescription Drugs | |||||
Most drugs not covered. | |||||
This plan does not offer prescription drug coverage. | |||||
Once you reach the plan deductible Medicare MSA plans cover Original Medicare benefits. Co-pay for Medicare MSAs is $0 once deductible is met. | |||||
Dental Services | |||||
Once you reach the plan deductible Medicare MSA plans cover Original Medicare benefits. Co-pay for Medicare MSAs is $0 once deductible is met. | |||||
Hearing Services | |||||
Once you reach the plan deductible Medicare MSA plans cover Original Medicare benefits. Co-pay for Medicare MSAs is $0 once deductible is met. | |||||
** Additional Benefits ** | |||||
Vision Services | |||||
Once you reach the plan deductible Medicare MSA plans cover Original Medicare benefits. Co-pay for Medicare MSAs is $0 once deductible is met. | |||||
Over-the-Counter Items | |||||
The plan does not cover Over-the-Counter items. | |||||
Transportation | |||||
This plan does not cover supplemental routine transportation. | |||||
Acupuncture | |||||
This plan does not cover Acupuncture. | |||||
** Inpatient Care ** | |||||
Inpatient Hospital Care | |||||
Once you reach the plan deductible Medicare MSA plans cover Original Medicare benefits. Co-pay for Medicare MSAs is $0 once deductible is met. | |||||
** Outpatient Care ** | |||||
Doctor Office Visits | |||||
Once you reach the plan deductible Medicare MSA plans cover Original Medicare benefits. Co-pay for Medicare MSAs is $0 once deductible is met. | |||||
Outpatient Services | |||||
Once you reach the plan deductible Medicare MSA plans cover Original Medicare benefits. Co-pay for Medicare MSAs is $0 once deductible is met. | |||||
Ambulance Services | |||||
Once you reach the plan deductible Medicare MSA plans cover Original Medicare benefits. Co-pay for Medicare MSAs is $0 once deductible is met. | |||||
** Outpatient Medical Services and Supplies ** | |||||
Durable Medical Equipment | |||||
Once you reach the plan deductible Medicare MSA plans cover Original Medicare benefits. Co-pay for Medicare MSAs is $0 once deductible is met. | |||||
Diagnostic Tests, X-Rays, Lab Services, and Radiology Services | |||||
Once you reach the plan deductible Medicare MSA plans cover Original Medicare benefits. Co-pay for Medicare MSAs is $0 once deductible is met. | |||||
** Additional Benefits ** | |||||
Over-the-Counter Items | |||||
The plan does not cover Over-the-Counter items. | |||||
Transportation | |||||
This plan does not cover supplemental routine transportation. |