2016 Medicare Advantage Plan Details | |||||
---|---|---|---|---|---|
Medicare Plan Name: | Advicare, Corp. (Medicare-Medicaid Plan) | ||||
Location: | Williamsburg, South Carolina Click to see other locations | ||||
Plan ID: | H7542 - 001 - 0 Click to see other plans | ||||
Member Services: | 1-844-564-0143 TTY users 1-888-357-7188 | ||||
— 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 Advicare, Corp. (Medicare-Medicaid Plan) benefit details | |||||
— Medicare Plan Features — | |||||
Monthly Premium: | $0.00 (see Plan Premium Details below) | ||||
Annual Rx Deductible: | $0 | ||||
Health Plan Type: | MMP | ||||
Maximum Out-of-Pocket Limit for Parts A & B (MOOP): | $0 | ||||
Additional Rx Gap Coverage? | Yes, some additional gap coverage. | ||||
Total Number of Formulary Drugs: | 3,030 drugs | Browse the Advicare, Corp. (Medicare-Medicaid Plan) Formulary | |||
This plan has 4 drug tiers. See cost-sharing for all pharmacies and tiers. | |||||
Formulary Drug Details: | Tier 1 | Tier 2 | Tier 3 | Tier 4 | Tier 5 |
• Preferred Pharmacy Cost-Sharing during initial coverage phase: | $0.00 | $0.00 | $0.00 | $0.00 | |
• Number of Drugs per Tier: | |||||
Plan's Pharmacy Search: | http://palmettophysicianconnections.comadvicarehealth.com | ||||
Plan Offers Mail Order? | Yes | ||||
Number of Members enrolled in this plan in Williamsburg, South Carolina: | less than 10 members | ||||
Number of Members enrolled in this plan in South Carolina: | less than 10 members | ||||
Number of Members enrolled in this plan in (H7542 - 001): | less than 10 members | ||||
Plan’s Summary Star Rating: | New plan - No summary rating as of yet. | ||||
• Customer Service Rating: | New plan - not yet rated. | ||||
• Member Experience Rating: | New plan - not yet rated. | ||||
• Drug Cost Accuracy Rating: | New plan - not yet rated. | ||||
— 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 ** | |||||
Monthly premium, deductible, and limits on how much you pay for covered services | |||||
You pay nothing | |||||
You pay nothing | |||||
In this plan you will pay nothing for services from any provider. | |||||
Please note that you will still need to pay your cost-sharing for your Part D prescription drugs. | |||||
Our plan has a coverage limit every year for certain in-network benefits. Contact us for the services that apply. | |||||
** Doctor and Hospital Choice ** | |||||
Acupuncture | |||||
Not covered | |||||
** Extra Benefits ** | |||||
Inpatient mental health care | |||||
For inpatient mental health care see the "Mental Health Care" section. | |||||
Outpatient prescription drugs | |||||
For Part B drugs such as chemotherapy drugs: You pay nothing | |||||
Other Part B drugs: You pay nothing | |||||
You may get your drugs at network retail pharmacies and mail order pharmacies. | |||||
You pay nothing | |||||
If you reside in a long-term care facility you pay the same as at a retail pharmacy. | |||||
You may get drugs from an out-of-network pharmacy at the same cost as an in-network pharmacy. | |||||
You pay nothing | |||||
Institutional care | |||||
Case management (long term care): You pay nothing | |||||
Institution for mental disease services for individuals 65 or older: You pay nothing | |||||
** Important Information ** | |||||
Monthly premium, deductible, and limits on how much you pay for covered services | |||||
You pay nothing | |||||
You pay nothing | |||||
In this plan you will pay nothing for services from any provider. | |||||
Please note that you will still need to pay your cost-sharing for your Part D prescription drugs. | |||||
Our plan has a coverage limit every year for certain in-network benefits. Contact us for the services that apply. | |||||
** Outpatient Care and Services ** | |||||
Acupuncture | |||||
Not covered | |||||
Additional home care services | |||||
Home and community based services: You pay nothing | |||||
Personal care services: You pay nothing | |||||
Private duty nursing services: You pay nothing | |||||
Self-directed personal assistance services: You pay nothing | |||||
Additional services | |||||
Case management: You pay nothing | |||||
Palliative Care: You pay nothing | |||||
Outpatient Mental Health Services: You pay nothing | |||||
Infusion Centers: You pay nothing | |||||
Residential Personal Care Services: You pay nothing | |||||
Nursing Home Transition Services (for up to 1 session every year): You pay nothing | |||||
Respite Care (for up to 14 sessions every year): You pay nothing | |||||
Adult Day Health Services & Nursing Services: You pay nothing | |||||
Environmental Modifications: You pay nothing (there is a limit to how much our plan will pay) | |||||
Telemedicine: You pay nothing | |||||
Companion Services (for up to 28 hours every week): You pay nothing | |||||
Adult Day Health Transportation: You pay nothing | |||||
Two (2) Additional Prescription Drugs: You pay nothing | |||||
Personal Emergency Response System: You pay nothing | |||||
Meal Benefit (for up to 2 meals every day): You pay nothing | |||||
Oral Nutritional Supplements (Cans): You pay nothing | |||||
Ambulance | |||||
You pay nothing | |||||
Chiropractic care | |||||
Manipulation of the spine to correct a subluxation (when 1 or more of the bones of your spine move out of position): You pay nothing | |||||
Dental services | |||||
Limited dental services (this does not include services in connection with care treatment filling removal or replacement of teeth): You pay nothing | |||||
Diabetes supplies and services | |||||
Diabetes monitoring supplies: You pay nothing | |||||
Diabetes self-management training: You pay nothing | |||||
Therapeutic shoes or inserts: You pay nothing | |||||
Diagnostic tests, lab and radiology services, and x-rays (Costs for these services may be different if received in an outpatient surgery setting) | |||||
Diagnostic radiology services (such as MRIs CT scans): You pay nothing | |||||
Diagnostic tests and procedures: You pay nothing | |||||
Lab services: You pay nothing | |||||
Outpatient x-rays: You pay nothing | |||||
Therapeutic radiology services (such as radiation treatment for cancer): You pay nothing | |||||
Doctor's office visits | |||||
Primary care physician visit: You pay nothing | |||||
Specialist visit: You pay nothing | |||||
Durable medical equipment (wheelchairs, oxygen, etc.) | |||||
You pay nothing | |||||
Specialized Supplies: You pay nothing | |||||
Emergency care | |||||
You pay nothing | |||||
Foot care (podiatry services) | |||||
Foot exams and treatment if you have diabetes-related nerve damage and/or meet certain conditions: You pay nothing | |||||
Hearing services | |||||
Exam to diagnose and treat hearing and balance issues: You pay nothing | |||||
Home health care | |||||
You pay nothing | |||||
Personal Care Services (for up to 50 visits every year): You pay nothing | |||||
Incontinence Supples (for up to 12 sessions every year): You pay nothing. | |||||
Mental health care | |||||
Inpatient visit: | |||||
Our plan covers up to 190 days in a lifetime for inpatient mental health care in a psychiatric hospital. The inpatient hospital care limit does not apply to inpatient mental services provided in a general hospital. | |||||
Our plan covers 90 days for an inpatient hospital stay. | |||||
Our plan also covers 60 "lifetime reserve days." These are "extra" days that we cover. If your hospital stay is longer than 90 days you can use these extra days. But once you have used up these extra 60 days your inpatient hospital coverage will be limited to 90 days. | |||||
You pay nothing | |||||
Outpatient group therapy visit: You pay nothing | |||||
Outpatient individual therapy visit: You pay nothing | |||||
Outpatient rehabilitation | |||||
Cardiac (heart) rehab services (for a maximum of 2 one-hour sessions per day for up to 36 sessions up to 36 weeks): You pay nothing | |||||
Occupational therapy visit: You pay nothing | |||||
Physical therapy and speech and language therapy visit: You pay nothing | |||||
Outpatient substance abuse | |||||
Group therapy visit: You pay nothing | |||||
Individual therapy visit: You pay nothing | |||||
Outpatient surgery | |||||
Ambulatory surgical center: You pay nothing | |||||
Outpatient hospital: You pay nothing | |||||
Over-the-counter items | |||||
Not Covered | |||||
Prosthetic devices (braces, artificial limbs, etc.) | |||||
Prosthetic devices: You pay nothing | |||||
Related medical supplies: You pay nothing | |||||
Medical Supplies: You pay nothing | |||||
Renal dialysis | |||||
You pay nothing | |||||
Transportation | |||||
Not covered | |||||
Urgently needed services | |||||
You pay nothing | |||||
Vision services | |||||
Exam to diagnose and treat diseases and conditions of the eye (including yearly glaucoma screening): You pay nothing | |||||
Routine eye exam (for up to 1 every year): You pay nothing | |||||
Our plan pays up to $150 every year for routine eye exams. | |||||
Contact lenses (for up to 1 every year): You pay nothing | |||||
Eyeglasses (frames and lenses) (for up to 1 every year): You pay nothing | |||||
Eyeglasses or contact lenses after cataract surgery: You pay nothing | |||||
Our plan pays up to $100 every year for contact lenses and eyeglasses (frames and lenses). | |||||
** Hospice ** | |||||
Hospice | |||||
You pay nothing for hospice care from a Medicare-certified hospice. You may have to pay part of the cost for drugs and respite care. | |||||
** Preventive Care ** | |||||
Preventive care | |||||
You pay nothing | |||||
Our plan covers many preventive services including:
| |||||
Family planning services: You pay nothing | |||||
** Inpatient Care ** | |||||
Inpatient hospital care | |||||
Our plan covers 90 days for an inpatient hospital stay. | |||||
Our plan also covers 60 "lifetime reserve days." These are "extra" days that we cover. If your hospital stay is longer than 90 days you can use these extra days. But once you have used up these extra 60 days your inpatient hospital coverage will be limited to 90 days. | |||||
You pay nothing | |||||
Inpatient mental health care | |||||
For inpatient mental health care see the "Mental Health Care" section. | |||||
Institutional care | |||||
Case management (long term care): You pay nothing | |||||
Institution for mental disease services for individuals 65 or older: You pay nothing | |||||
Skilled Nursing Facility (SNF) | |||||
Our plan covers up to 100 days in a SNF. | |||||
You pay nothing | |||||
Outpatient prescription drugs | |||||
For Part B drugs such as chemotherapy drugs: You pay nothing | |||||
Other Part B drugs: You pay nothing | |||||
You may get your drugs at network retail pharmacies and mail order pharmacies. | |||||
You pay nothing | |||||
If you reside in a long-term care facility you pay the same as at a retail pharmacy. | |||||
You may get drugs from an out-of-network pharmacy at the same cost as an in-network pharmacy. | |||||
You pay nothing | |||||
Additional home care services | |||||
Home and community based services: You pay nothing | |||||
Personal care services: You pay nothing | |||||
Private duty nursing services: You pay nothing | |||||
Self-directed personal assistance services: You pay nothing | |||||
** Outpatient Care ** | |||||
Diabetes supplies and services | |||||
Diabetes monitoring supplies: You pay nothing | |||||
Diabetes self-management training: You pay nothing | |||||
Therapeutic shoes or inserts: You pay nothing | |||||
Foot care (podiatry services) | |||||
Foot exams and treatment if you have diabetes-related nerve damage and/or meet certain conditions: You pay nothing | |||||
Hearing services | |||||
Exam to diagnose and treat hearing and balance issues: You pay nothing | |||||
** Outpatient Medical Services and Supplies ** | |||||
Outpatient substance abuse | |||||
Group therapy visit: You pay nothing | |||||
Individual therapy visit: You pay nothing | |||||
Prosthetic devices (braces, artificial limbs, etc.) | |||||
Prosthetic devices: You pay nothing | |||||
Related medical supplies: You pay nothing | |||||
Medical Supplies: You pay nothing | |||||
** Additional Benefits ** | |||||
Inpatient mental health care | |||||
For inpatient mental health care see the "Mental Health Care" section. | |||||
Institutional care | |||||
Case management (long term care): You pay nothing | |||||
Institution for mental disease services for individuals 65 or older: You pay nothing |