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2020 AARP Medicare Advantage Choice (PPO) in Buchanan, Iowa

Medicare Advantage Plan Benefit Details in Plain Text

The following Medicare Advantage plan benefits apply to the AARP Medicare Advantage Choice (PPO) (H8768 - 017) in Buchanan, Iowa .

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 AARP Medicare Advantage Choice (PPO) health and prescription benefit details in chart format

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Plan Premium

This plan has a $0.00 monthly premium. Although you pay no additional monthly premium, you must continue to pay 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 PPO plan.

Plan Membership and Plan Ratings

The AARP Medicare Advantage Choice (PPO) (H8768 - 017) currently has 10,134 members. There are 68 members enrolled in this plan in Buchanan, Iowa, and 7,773 members in Iowa.

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:

Customer Service Rating of 5 out of 5 stars
Member Experience Rating of 4 out of 5 stars
Drug Cost Information Accuracy Rating of 4 out of 5 stars

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 2020 is $435. This plan (AARP Medicare Advantage Choice (PPO)) has no deductible.

The following information is about the AARP Medicare Advantage Choice (PPO) formulary (or drug list). There are 3601 drugs on the AARP Medicare Advantage Choice (PPO) formulary. Click here to browse the AARP Medicare Advantage Choice (PPO) 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 AARP Medicare Advantage Choice (PPO)’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 0 drugs and has a co-payment of $3.00.
Tier 2 (Generic) contains 0 drugs and has a co-payment of $10.00.
Tier 3 (Preferred Brand) contains 0 drugs and has a co-payment of $47.00.
Tier 4 (Non-Preferred Drug) contains 0 drugs and has a co-payment of $100.00.
Tier 5 (Specialty Tier) contains 0 drugs and has a co-insurance of 33% of the drug cost.

Click here to browse the AARP Medicare Advantage Choice (PPO) 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 75% 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 (AARP Medicare Advantage Choice (PPO)) offers No Coverage during the Coverage Gap phase.

The AARP Medicare Advantage Choice (PPO) offers many Health and Prescription Drug Coverage Benefits. The following section will describe these benefits in detail.

Base Plan
Premium
• Health plan premium: $0
• Drug plan premium: $0
• You must continue to pay your Part B premium.
• Part B premium reduction: No
Deductible
• Health plan deductible: $1,000 annual deductible
• Other health plan deductibles: In-network: No
• Drug plan deductible: No annual deductible
Maximum out-of-pocket enrollee responsibility (does not include prescription drugs)
• $6,700 In and Out-of-network $4,100 In-network
Optional supplemental benefits
• No
Additional benefits and/or reduced cost-sharing for enrollees with certain health conditions?
• In-network: No
Doctor visits
• Primary In-network: $0 copay
• Primary Out-of-network: $15-55 copay per visit
• Specialist In-network: $40 copay per visit (authorization required)
• Specialist Out-of-network: $55 copay per visit (authorization required)
Diagnostic procedures/lab services/imaging
• Diagnostic tests and procedures In-network: $30 copay (authorization required)
• Diagnostic tests and procedures Out-of-network: $30 copay (authorization required)
• Lab services In-network: $0 copay (authorization required)
• Lab services Out-of-network: $0 copay (authorization required)
• Diagnostic radiology services (e.g., MRI) In-network: $0-145 copay (authorization required)
• Diagnostic radiology services (e.g., MRI) Out-of-network: $0-145 copay or 40% coinsurance (authorization required)
• Outpatient x-rays In-network: $14 copay (authorization required)
• Outpatient x-rays Out-of-network: $14 copay (authorization required)
Emergency care/Urgent care
• Emergency: $90 copay per visit (always covered)
• Urgent care: $30-40 copay per visit (always covered)
Inpatient hospital coverage
• In-network: $750 per stay $0 per day for days 91 and beyond (authorization required)
• Out-of-network: $750 per stay (authorization required)
Outpatient hospital coverage
• In-network: $0-300 copay per visit (authorization required)
• Out-of-network: $0-300 copay per visit (authorization required)
Skilled Nursing Facility
• In-network: $0 per day for days 1 through 20 $160 per day for days 21 through 46 $0 per day for days 47 through 100 (authorization required)
• Out-of-network: $150 per day for days 1 through 16 $250 per day for days 17 through 34 $0 per day for days 35 through 100 (authorization required)
Preventive care
• In-network: $0 copay
• Out-of-network: $0 copay
Ground ambulance
• In-network: $250 copay
• Out-of-network: $250 copay
Rehabilitation services
• Occupational therapy visit In-network: $40 copay (authorization required)
• Occupational therapy visit Out-of-network: $40 copay (authorization required)
• Physical therapy and speech and language therapy visit In-network: $40 copay (authorization required)
• Physical therapy and speech and language therapy visit Out-of-network: $40 copay (authorization required)
Mental health services
• Inpatient hospital - psychiatric In-network: $750 per stay (authorization required)
• Inpatient hospital - psychiatric Out-of-network: $750 per stay (authorization required)
• Outpatient group therapy visit with a psychiatrist In-network: $0 copay (authorization required)
• Outpatient group therapy visit with a psychiatrist Out-of-network: $0 copay (authorization required)
• Outpatient individual therapy visit with a psychiatrist In-network: $0 copay (authorization required)
• Outpatient individual therapy visit with a psychiatrist Out-of-network: $0 copay (authorization required)
• Outpatient group therapy visit In-network: $0 copay (authorization required)
• Outpatient group therapy visit Out-of-network: $0 copay (authorization required)
• Outpatient individual therapy visit In-network: $0 copay (authorization required)
• Outpatient individual therapy visit Out-of-network: $0 copay (authorization required)
Opioid treatment program services
• In-network: $0.00 copay
Medical equipment/supplies
• Durable medical equipment (e.g., wheelchairs, oxygen) In-network: 20% coinsurance per item (authorization required)
• Durable medical equipment (e.g., wheelchairs, oxygen) Out-of-network: 50% coinsurance per item (authorization required)
• Prosthetics (e.g., braces, artificial limbs) In-network: 20% coinsurance per item (authorization required)
• Prosthetics (e.g., braces, artificial limbs) Out-of-network: 20% coinsurance per item (authorization required)
• Diabetes supplies In-network: $0 copay per item (authorization required)
• Diabetes supplies Out-of-network: 20% coinsurance per item (authorization required)
Dialysis
• 20% coinsurance (authorization required)
Hearing
• Hearing exam In-network: $0 copay (authorization required)
• Hearing exam Out-of-network: $55 copay (authorization required)
• Fitting/evaluation: Not covered
• Hearing aids In-network: $375-2,075 copay (limits apply, authorization required)
• Hearing aids Out-of-network: $375 copay (limits apply, authorization required)
Preventive dental
• Oral exam In-network: $0 copay (limits apply)
• Oral exam Out-of-network: $0 copay (limits apply)
• Cleaning In-network: $0 copay (limits apply)
• Cleaning Out-of-network: $0 copay (limits apply)
• Fluoride treatment In-network: $0 copay (limits apply)
• Fluoride treatment Out-of-network: $0 copay (limits apply)
• Dental x-ray(s) In-network: $0 copay (limits apply)
• Dental x-ray(s) Out-of-network: $0 copay (limits apply)
Comprehensive dental
• Non-routine services In-network: 50% coinsurance (limits apply, authorization required)
• Non-routine services Out-of-network: 0-50% coinsurance (limits apply, authorization required)
• Diagnostic services: Not covered
• Restorative services In-network: 0-50% coinsurance (limits apply, authorization required)
• Restorative services Out-of-network: 0-50% coinsurance (limits apply, authorization required)
• Endodontics In-network: 50% coinsurance (limits apply, authorization required)
• Endodontics Out-of-network: 0-50% coinsurance (limits apply, authorization required)
• Periodontics In-network: 50% coinsurance (limits apply, authorization required)
• Periodontics Out-of-network: 0-50% coinsurance (limits apply, authorization required)
• Extractions In-network: 50% coinsurance (limits apply, authorization required)
• Extractions Out-of-network: 0-50% coinsurance (limits apply, authorization required)
• Prosthodontics, other oral/maxillofacial surgery, other services In-network: 0-50% coinsurance (limits apply, authorization required)
• Prosthodontics, other oral/maxillofacial surgery, other services Out-of-network: 0-50% coinsurance (limits apply, authorization required)
Vision
• Routine eye exam In-network: $0 copay (limits apply, authorization required)
• Routine eye exam Out-of-network: $0 copay (limits apply, authorization required)
• Other: Not covered
• Contact lenses In-network: $0 copay (limits apply)
• Contact lenses Out-of-network: 50% coinsurance (limits apply)
• Eyeglasses (frames and lenses) In-network: $0 copay (limits apply)
• Eyeglasses (frames and lenses) Out-of-network: 50% coinsurance (limits apply)
• Eyeglass frames: Not covered
• Eyeglass lenses: Not covered
• Upgrades: Not covered
Wellness programs (e.g., fitness, nursing hotline)
• Covered
Transportation
• Not covered
Foot care (podiatry services)
• Foot exams and treatment In-network: $40 copay (authorization required)
• Foot exams and treatment Out-of-network: $55 copay (authorization required)
• Routine foot care In-network: $40 copay (limits apply, authorization required)
• Routine foot care Out-of-network: $55 copay (limits apply, authorization required)
Medicare Part B drugs
• Chemotherapy In-network: 20% coinsurance (authorization required)
• Chemotherapy Out-of-network: $0-145 copay or 40% coinsurance (authorization required)
• Other Part B drugs In-network: 20% coinsurance (authorization required)
• Other Part B drugs Out-of-network: $0-145 copay or 40% coinsurance (authorization required)
Medically-approved non-opioid pain management services
• Chiropractic services: Not covered
• Acupuncture: Not covered
• Therapeutic Massage: Not covered
• Alternative Therapies: Not covered
More benefits
• Over-the-counter drug benefits: Some coverage
• Meals for short duration: Not covered
• Annual physical exams: Some coverage
• Telehealth: Some coverage
• WorldWide emergency transportation: Some coverage
• WorldWide emergency coverage: Some coverage
• WorldWide emergency urgent care: Some coverage
• Fitness Benefit: Some coverage
• In-Home Support Services: Not covered
• Bathroom Safety Devices: Not covered
• Health Education: Not covered
• In-Home Safety Assessment: Not covered
• Personal Emergency Response System (PERS): Some coverage
• Medical Nutrition Therapy (MNT): Not covered
• Post discharge In-Home Medication Reconciliation: Not covered
• Re-admission Prevention: Not covered
• Wigs for Hair Loss Related to Chemotherapy: Not covered
• Weight Management Programs: Not covered
• Adult Day Health Services: Not covered
• Nutritional/Dietary Benefit: Not covered
• Home-Based Palliative Care: Not covered
• Support for Caregivers of Enrollees: Not covered
• Additional Sessions of Smoking and Tobacco Cessation Counseling: Not covered
• Enhanced Disease Management: Not covered
• Telemonitoring Services: Not covered
• Remote Access Technologies (including Web/Phone-based technologies and Nursing Hotline): Some coverage
• Counseling Services: Not covered

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