2021 Medicare Advantage Plan Details | |||||
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Medicare Plan Name: | Lasso Healthcare Growth (MSA) | ||||
Location: | Randolph, West Virginia Click to see other locations | ||||
Plan ID: | H1924 - 001 - 0 Click to see other plans | ||||
Member Services: | |||||
— 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 Lasso Healthcare Growth (MSA) benefit details | |||||
— Medicare Plan Features — | |||||
Monthly Premium: | MSAs do not have a monthly premium. | ||||
Annual Rx Deductible: | no drug coverage | ||||
Health Plan Type: | MSA * | ||||
Maximum Out-of-Pocket Limit for Parts A & B (MOOP): | $0 | ||||
Number of Members enrolled in this plan in Randolph, West Virginia: | less than 10 members | ||||
Number of Members enrolled in this plan in West Virginia: | less than 10 members | ||||
Number of Members enrolled in this plan in (H1924 - 001): | 4,888 members | ||||
Plan’s Summary Star Rating: | New plan - No summary rating as of yet. | ||||
• Customer Service Rating: | Plan not required to report measure. | ||||
• Member Experience Rating: | Plan not required to report measure. | ||||
• Drug Cost Accuracy Rating: | Plan not required to report measure. |
— Plan Health Benefits — | |||||
** 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: $5,000 annual deductible | |||||
• Other health plan deductibles: In-network: No | |||||
Maximum out-of-pocket enrollee responsibility (does not include prescription drugs) | |||||
• Not Applicable | |||||
Optional supplemental benefits | |||||
• No | |||||
Additional benefits and/or reduced cost-sharing for enrollees with certain health conditions? | |||||
• In-network: No | |||||
Doctor visits | |||||
• Primary: $0 copay after you pay your deductible | |||||
• Specialist: $0 copay after you pay your deductible | |||||
Diagnostic procedures/lab services/imaging | |||||
• Diagnostic tests and procedures: $0 copay after you pay your deductible | |||||
• Lab services: $0 copay after you pay your deductible | |||||
• Diagnostic radiology services (e.g., MRI): $0 copay after you pay your deductible | |||||
• Outpatient x-rays: $0 copay after you pay your deductible | |||||
Emergency care/Urgent care | |||||
• Emergency: $0 copay after you pay your deductible | |||||
• Urgent care: $0 copay after you pay your deductible | |||||
Inpatient hospital coverage | |||||
• $0 copay after you pay your deductible | |||||
Outpatient hospital coverage | |||||
• $0 copay after you pay your deductible | |||||
Skilled Nursing Facility | |||||
• $0 copay after you pay your deductible | |||||
Preventive care | |||||
• $0 copay | |||||
Ground ambulance | |||||
• $0 copay after you pay your deductible | |||||
Rehabilitation services | |||||
• Occupational therapy visit: $0 copay after you pay your deductible | |||||
• Physical therapy and speech and language therapy visit: $0 copay after you pay your deductible | |||||
Mental health services | |||||
• Inpatient hospital - psychiatric: $0 copay after you pay your deductible | |||||
• Outpatient group therapy visit with a psychiatrist: $0 copay after you pay your deductible | |||||
• Outpatient individual therapy visit with a psychiatrist: $0 copay after you pay your deductible | |||||
• Outpatient group therapy visit: $0 copay after you pay your deductible | |||||
• Outpatient individual therapy visit: $0 copay after you pay your deductible | |||||
Medical equipment/supplies | |||||
• Durable medical equipment (e.g., wheelchairs, oxygen): $0 copay after you pay your deductible | |||||
• Prosthetics (e.g., braces, artificial limbs): $0 copay after you pay your deductible | |||||
• Diabetes supplies: $0 copay after you pay your deductible | |||||
Hearing | |||||
• Hearing exam: $0 copay after you pay your deductible | |||||
• Fitting/evaluation: Not covered | |||||
• Hearing aids - inner ear: Not covered | |||||
• Hearing aids - outer ear: Not covered | |||||
• Hearing aids - over the ear: Not covered | |||||
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 | |||||
Vision | |||||
• Routine eye exam: Not covered | |||||
• Other: Not covered | |||||
• Contact lenses: Not covered | |||||
• Eyeglasses (frames and lenses): Not covered | |||||
• Eyeglass frames: Not covered | |||||
• Eyeglass lenses: Not covered | |||||
• Upgrades: Not covered | |||||
Wellness programs (e.g., fitness, nursing hotline) | |||||
• Not covered | |||||
Transportation | |||||
• Not covered | |||||
Foot care (podiatry services) | |||||
• Foot exams and treatment: $0 copay after you pay your deductible | |||||
• Routine foot care: Not covered | |||||
Medicare Part B drugs | |||||
• Chemotherapy: $0 copay after you pay your deductible | |||||
• Other Part B drugs: $0 copay after you pay your deductible |