2016 Medicare Advantage Plan Details | |||||
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Medicare Plan Name: | Presbyterian Senior Care Plan 1 (HMO) | ||||
Location: | Socorro, New Mexico Click to see other locations | ||||
Plan ID: | H3204 - 008 - 0 Click to see other plans | ||||
Member Services: | 1-800-797-5343 TTY users 1-800-659-8331 | ||||
— 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 Presbyterian Senior Care Plan 1 (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): | $2,500 | ||||
Number of Members enrolled in this plan in Socorro, New Mexico: | less than 10 members | ||||
Number of Members enrolled in this plan in New Mexico: | 1,744 members | ||||
Number of Members enrolled in this plan in (H3204 - 008): | 1,778 members | ||||
Plan’s Summary Star Rating: | 4.5 out of 5 Stars. | ||||
• Customer Service Rating: | 4 out of 5 Stars. | ||||
• Member Experience Rating: | 4 out of 5 Stars. | ||||
• Drug Cost Accuracy Rating: | 4 out of 5 Stars. | ||||
— 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 | |||||
$0.00 per month. In addition you must keep paying your Medicare Part B premium. | |||||
This plan does not have a deductible. | |||||
Yes. Like all Medicare health plans our plan protects you by having yearly limits on your out-of-pocket costs for medical and hospital care. | |||||
Your yearly limit(s) in this plan: | |||||
| |||||
If you reach the limit on out-of-pocket costs you keep getting covered hospital and medical services and we will pay the full cost for the rest of the year. Please note that you will still need to pay your monthly premiums. | |||||
No. There are no limits on how much our plan will pay. | |||||
** Doctor and Hospital Choice ** | |||||
Acupuncture | |||||
For up to 20 visit(s) every year: $15 copay | |||||
** 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 drugs1: 5% of the cost | |||||
Other Part B drugs1: 0-5% of the cost depending on the drug | |||||
Our plan does not cover Part D prescription drug. | |||||
** Important Information ** | |||||
Monthly premium, deductible, and limits on how much you pay for covered services | |||||
$0.00 per month. In addition you must keep paying your Medicare Part B premium. | |||||
This plan does not have a deductible. | |||||
Yes. Like all Medicare health plans our plan protects you by having yearly limits on your out-of-pocket costs for medical and hospital care. | |||||
Your yearly limit(s) in this plan: | |||||
| |||||
If you reach the limit on out-of-pocket costs you keep getting covered hospital and medical services and we will pay the full cost for the rest of the year. Please note that you will still need to pay your monthly premiums. | |||||
No. There are no limits on how much our plan will pay. | |||||
** Outpatient Care and Services ** | |||||
Acupuncture | |||||
For up to 20 visit(s) every year: $15 copay | |||||
Ambulance | |||||
$100 copay | |||||
Chiropractic care | |||||
Manipulation of the spine to correct a subluxation (when 1 or more of the bones of your spine move out of position): $20 copay | |||||
Dental services | |||||
Limited dental services (this does not include services in connection with care treatment filling removal or replacement of teeth): $35 copay | |||||
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): $250 copay | |||||
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: $5 copay | |||||
Specialist visit: $35 copay | |||||
Durable medical equipment (wheelchairs, oxygen, etc.) | |||||
0-10% of the cost depending on the equipment | |||||
Emergency care | |||||
$75 copay | |||||
If you are admitted to the hospital within 24 hours you do not have to pay your share of the cost for emergency care. See the "Inpatient Hospital Care" section for other costs. | |||||
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: $35 copay | |||||
Routine hearing exam (for up to 1 every year): $35 copay | |||||
Home health care | |||||
You pay nothing | |||||
Mental health care | |||||
Inpatient visit: | |||||
Our plan covers an unlimited number of days for an inpatient hospital stay. | |||||
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. Additional visits are covered but your cost may be more. | |||||
Occupational therapy visit: $10 copay | |||||
Physical therapy and speech and language therapy visit: $10 copay | |||||
Outpatient substance abuse | |||||
Group therapy visit: You pay nothing | |||||
Individual therapy visit: You pay nothing | |||||
Outpatient surgery | |||||
Ambulatory surgical center: $225 copay | |||||
Outpatient hospital: $225 copay | |||||
Over-the-counter items | |||||
Not Covered | |||||
Prosthetic devices (braces, artificial limbs, etc.) | |||||
Prosthetic devices: 10% of the cost | |||||
Related medical supplies: 0-10% of the cost depending on the supply | |||||
Renal dialysis | |||||
You pay nothing | |||||
Transportation | |||||
Not covered | |||||
Urgently needed services | |||||
$5-65 copay depending on the service | |||||
Vision services | |||||
Exam to diagnose and treat diseases and conditions of the eye (including yearly glaucoma screening): $0-35 copay depending on the service | |||||
Routine eye exam (for up to 1 every year): $0-35 copay depending on the service | |||||
Eyeglasses or contact lenses after cataract surgery: 10% of the cost | |||||
** 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:
| |||||
** Inpatient Care ** | |||||
Inpatient hospital care | |||||
Our plan covers an unlimited number of days for an inpatient hospital stay. | |||||
Inpatient mental health care | |||||
For inpatient mental health care see the "Mental Health Care" section. | |||||
Skilled Nursing Facility (SNF) | |||||
Our plan covers up to 100 days in a SNF. | |||||
Outpatient prescription drugs | |||||
For Part B drugs such as chemotherapy drugs1: 5% of the cost | |||||
Other Part B drugs1: 0-5% of the cost depending on the drug | |||||
Our plan does not cover Part D prescription drug. | |||||
** 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: $35 copay | |||||
Routine hearing exam (for up to 1 every year): $35 copay | |||||
** 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: 10% of the cost | |||||
Related medical supplies: 0-10% of the cost depending on the supply | |||||
** Additional Benefits ** | |||||
Inpatient mental health care | |||||
For inpatient mental health care see the "Mental Health Care" section. |