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

2019 Paramount Elite - Enhanced Medical and Drug (HMO) in Fulton, Ohio

Medicare Advantage Plan Benefit Details in Plain Text
The following Medicare Advantage plan benefits apply to the Paramount Elite - Enhanced Medical and Drug (HMO) (H3653 - 004) in Fulton, Ohio .

This plan is administered by PARAMOUNT CARE, INC..  To switch to a different Medicare Advantage plan or to change your location, click here.
Click here to see the Paramount Elite - Enhanced Medical and Drug (HMO) health and prescription benefit details in chart format or email and view benefits chart

Plan Premium
The Paramount Elite - Enhanced Medical and Drug (HMO) has a monthly premium of $68.00. That is $816.00 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 $68.00 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 with Prescription Drug Coverage is a Local HMO plan.

Plan Membership and Plan Ratings
The Paramount Elite - Enhanced Medical and Drug (HMO) (H3653 - 004) currently has 9,256 members. There are 256 members enrolled in this plan in Fulton, Ohio.

The Centers for Medicare and Medicaid Services (CMS) has given this plan carrier a summary rating of 4 stars. The detail CMS plan carrier ratings are as follows:
Prescription Drug Coverage: Deductible, Cost-sharing, Formulary
This plan does NOT have a deductible for the prescription drug coverage. That means that you have first dollar coverage. Some plans have a deductible that must be paid (in full) prior to the prescription coverage assisting in your prescription costs (see cost-sharing below). The maximum deductible for 2019 is $415. This plan (Paramount Elite - Enhanced Medical and Drug (HMO)) has no deductible.

The following information is about the Paramount Elite - Enhanced Medical and Drug (HMO) formulary (or drug list). There are 4086 drugs on the Paramount Elite - Enhanced Medical and Drug (HMO) formulary. Click here to browse the Paramount Elite - Enhanced Medical and Drug (HMO) Formulary.
 
The Initial Coverage Phase (ICP) can be thought of as the cost-sharing phase of the plan. During this phase, you and the insurance company share your prescription costs. Since this plan has no deductible, your coverage (initial coverage phase) will start right away. All medication are divided into tiers within the plans formulary. This helps the plan to organize and manage the prescription cost-sharing. The Paramount Elite - Enhanced Medical and Drug (HMO)’s formulary is divided into 5 tiers. Every plan can name their tiers differently, and can place medications on any tier. The cost-sharing for this plan is divided as follows:
  • Tier 1 (Preferred Generic) contains 428 drugs and has a co-payment of $0.00.
  • Tier 2 (Generic) contains 1,895 drugs and has a co-payment of $15.00.
  • Tier 3 (Preferred Brand) contains 349 drugs and has a co-payment of $45.00.
  • Tier 4 (Non-Preferred Drug) contains 726 drugs and has a co-payment of $100.00.
  • Tier 5 (Specialty Tier) contains 836 drugs and has a co-insurance of 33% of the drug cost.
    •  
Click here to browse the Paramount Elite - Enhanced Medical and Drug (HMO) Formulary.

The Coverage Gap, which is also known as the Donut (Doughnut) Hole is the phase of your Medicare Part D plan where you are responsible for 100% of your medication costs. Healthcare Reform mandates that the insurance carrier pay 63% of your generic drug prescription costs in the donut hole on your behalf.

The brand-name drug manufacturer will pay 70% and your plan will pay an additional 5% of the cost of your brand-name drugs purchased in the Donut Hole, for a total of 75% discount. The 70% paid by the brand-name drug manufacturer is paid on your behalf and therefore counts toward your TrOOP (or True Out-of-Pocket) costs. The portion paid by your plan, does not count toward TrOOP. Some Medicare Part D plans offer coverage during the Coverage Gap that is beyond the mandated discounts. Any drug not covered by the plan’s Gap Coverage will still receive the discounts noted above -- even if the plan has "No Gap Coverage". This plan (Paramount Elite - Enhanced Medical and Drug (HMO)) offers No Coverage during the Coverage Gap phase.

The Paramount Elite - Enhanced Medical and Drug (HMO) offers many Health and Prescription Drug Coverage Benefits. The following section will describe these benefits in detail.

** Benefit Highlights **
Health plan deductible
• $0
Maximum out-of-pocket enrollee responsibility (does not include prescription drugs)
• $3,400 In-network
Optional supplemental benefits
• Yes
Inpatient hospital coverage
• $200 per day for days 1 through 5
$0 per day for days 6 through 90
Outpatient hospital coverage
• $200 per visit
Preventive care
• $0 copay
Other health plan deductibles?
• In-Network:  Yes
Additional benefits and/or reduced cost-sharing for enrollees with certain health conditions?
• In-Network:  No
Doctor visits
• Primary:  $0 copay
• Specialist:  $40 per visit
Emergency care/Urgent care
• Emergency:  $120 per visit (always covered)
• Urgent care:  $45 per visit (always covered)
Skilled Nursing Facility
• $0 per day for days 1 through 9
$20 per day for days 10 through 20
$155 per day for days 21 through 100
Ground ambulance
• $150
Transportation
• Not covered
Wellness programs (e.g., fitness, nursing hotline)
• Covered
Vision
• Routine eye exam:  $0 copay
• Other:  Not covered
• Contact lenses:  $0 copay
• Eyeglasses (frames and lenses):  Not covered
• Eyeglass frames:  $0 copay
• Eyeglass lenses:  $0 copay
• Upgrades:  Not covered
Mental health services
• Inpatient hospital - psychiatric:  $200 per day for days 1 through 5
$0 per day for days 6 through 90
• Outpatient group therapy visit with a psychiatrist:  $40
• Outpatient individual therapy visit with a psychiatrist:  $40
• Outpatient group therapy visit:  $40
• Outpatient individual therapy visit:  $40
Rehabilitation services
• Occupational therapy visit:  $25
• Physical therapy and speech and language therapy visit:  $25
Foot care (podiatry services)
• Foot exams and treatment:  $40
• Routine foot care:  Not covered
Medical equipment/supplies
• Durable medical equipment (e.g., wheelchairs, oxygen):  20% per item
• Prosthetics (e.g., braces, artificial limbs):  20% per item
• Diabetes supplies:  $0 copay
Medicare Part B drugs
• Chemotherapy:  20%
• Other Part B drugs:  20%
** Benefits Services **
Diagnostic procedures/lab services/imaging
• Diagnostic tests and procedures:  $10
• Lab services:  $0-10
• Diagnostic radiology services (e.g., MRI):  $150
• Outpatient x-rays:  $10
Hearing
• Hearing exam:  $40
• Fitting/evaluation:  Not covered
• Hearing aids:  $699-999
Preventive dental
• Oral exam:  Not covered
• Cleaning:  Not covered
• Fluoride treatment:  Not covered
• Dental x-ray(s):  Not covered
Comprehensive dental
• Non-routine services:  Not covered
• Diagnostic services:  Not covered
• Restorative services:  Not covered
• Endodontics:  Not covered
• Periodontics:  Not covered
• Extractions:  Not covered
• Prosthodontics, other oral/maxillofacial surgery, other services:  Not covered
** Optional Supplemental Benefits **
Package #2
• Comprehensive dental, Preventive dental
Package #1
• Preventive dental
• Monthly Premium:  $18.10
Package #2
• Monthly Premium:  $30.00
Package #1
• Deductible:  N/A
Package #2
• Deductible:  $25.00




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