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

2019 SeniorCare Advantage Premium (HMO) in Milam, Texas

Medicare Advantage Plan Benefit Details in Plain Text
The following Medicare Advantage plan benefits apply to the SeniorCare Advantage Premium (HMO) (H8142 - 006) in Milam, Texas .

This plan is administered by .  To switch to a different Medicare Advantage plan or to change your location, click here.
Click here to see the SeniorCare Advantage Premium (HMO) health benefit details in chart format or email and view benefits chart

Plan Premium
The SeniorCare Advantage Premium (HMO) has a monthly premium of $199.00. That is $2,388.00 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 $199.00 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 without Prescription Drug Coverage is a Local HMO * plan.

Plan Membership and Plan Ratings
The SeniorCare Advantage Premium (HMO) (H8142 - 006) currently has 437 members. There are 28 members enrolled in this plan in Milam, Texas.

The Centers for Medicare and Medicaid Services (CMS) has given this plan carrier a summary rating of 4.5 stars. The detail CMS plan carrier ratings are as follows:
Please be aware that this plan does NOT include Prescription Drug Coverage!
The SeniorCare Advantage Premium (HMO) offers many Health 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
• No
Inpatient hospital coverage
• $0 copay
Outpatient hospital coverage
• $0 copay
Preventive care
• $0 copay
Other health plan deductibles?
• In-Network:  No
Additional benefits and/or reduced cost-sharing for enrollees with certain health conditions?
• In-Network:  No
Doctor visits
• Primary:  $0 copay
• Specialist:  $0 copay
Emergency care/Urgent care
• Emergency:  $120 per visit (always covered)
• Urgent care:  $40 per visit (always covered)
Skilled Nursing Facility
• $0 per day for days 1 through 20
$15 per day for days 21 through 100
Ground ambulance
• $40
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):  $0 copay
• Eyeglass frames:  $0 copay
• Eyeglass lenses:  $0 copay
• Upgrades:  Not covered
Mental health services
• Inpatient hospital - psychiatric:  $0 copay
• Outpatient group therapy visit with a psychiatrist:  $0 copay
• Outpatient individual therapy visit with a psychiatrist:  $0 copay
• Outpatient group therapy visit:  $0 copay
• Outpatient individual therapy visit:  $0 copay
Rehabilitation services
• Occupational therapy visit:  $0 copay
• Physical therapy and speech and language therapy visit:  $0 copay
Foot care (podiatry services)
• Foot exams and treatment:  $0 copay
• Routine foot care:  Not covered
Medical equipment/supplies
• Durable medical equipment (e.g., wheelchairs, oxygen):  $0 copay
• Prosthetics (e.g., braces, artificial limbs):  $0 copay
• Diabetes supplies:  $0 copay
Medicare Part B drugs
• Chemotherapy:  $0 copay
• Other Part B drugs:  $0 copay
** Benefits Services **
Diagnostic procedures/lab services/imaging
• Diagnostic tests and procedures:  $0 copay
• Lab services:  $0 copay
• Diagnostic radiology services (e.g., MRI):  $0 copay
• Outpatient x-rays:  $0 copay
Hearing
• Hearing exam:  $0 copay
• Fitting/evaluation:  $0 copay
• Hearing aids:  $0 copay
Preventive dental
• Oral exam:  $0 copay
• Cleaning:  $0 copay
• Fluoride treatment:  Not covered
• Dental x-ray(s):  $0 copay
Comprehensive dental
• Non-routine services:  Not covered
• Diagnostic services:  $0 copay
• Restorative services:  Not covered
• Endodontics:  Not covered
• Periodontics:  Not covered
• Extractions:  50%
• Prosthodontics, other oral/maxillofacial surgery, other services:  50%




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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.
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