2018 Full Dual (Medicare & Medicaid) Medicare Advantage Special Needs Plans (SNP) Maricopa County
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- Kristina Cummings
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1 2018 Full Dual (Medicare & Medicaid) Medicare Advantage Special Needs Plans (SNP) Maricopa County Special Needs Plans for Dual Eligible beneficiaries are an HMO plan that limits their membership to people who are eligible for both Medicare and Medicaid (AHCCCS). The Special Needs Plan must be designed to provide Medicare health care and services to people who can benefit the most from things like special expertise of the plan s providers, and focused care management. In some cases, you may have to choose a primary care doctor or have a care coordinator help you develop personal care plans and coordinate your care. You generally must get your care and services from doctors or hospitals in the plan s network (except emergency or urgent care). Most current revision 10/17/17 BENEFITS ASSISTANCE PROGRAM A State Health Insurance Assistance Program (SHIP) A program of the Area Agency on Aging, Region One 1366 East Thomas, Suite 108, Phoenix, AZ This project was supported in part by grant number 15AAAZMSHI, from the U.S. Administration for Community Living, Department of Health and Human Services, Washington, D.C Grantees undertaking projects under government sponsorship are encouraged to express freely their findings and conclusions. Points of view or opinions do not, therefore, necessarily represent official Administration for Community Living policy
2 Full Dual Special Needs Plans (D-SNPs) Page 1. Allwell Dual Medicare 3 2. Care1st Health Choice Generations 7 4. Mercy Care Advantage (option for ALTCS members) 9 5. UnitedHealthcare Dual Complete United Healthcare Dual Complete ONE (for ALTCS members only) University Care Advantage (for ALTCS members only) 15 AHCCCS Health Plans in Maricopa County (secondary insurance) Care 1 st Arizona Health Choice Arizona Health Net of Arizona Mercy Care Plan (option for ALTCS members) United Health Care Community Plan (option for ALTCS members) Banner University Family Care (option for ALTCS members only) Mercy Maricopa Integrated Care (must be SMI) American Indian Health Program (for Native Americans only) In order to be eligible for these plans, individuals need to be eligible for Medicare and FULL Medicaid (AHCCCS). In other words, they have to be eligible for QMB and an AHCCCS Health Plan. IMPORTANT: the AHCCCS income guideline changes from 138% of FPL to 100% when on Medicare. Make sure the client is at or under 100% of FPL before suggesting any of these plans. SLMB and QI-1 is not considered full Medicaid.* - 2 -
3 Allwell Dual Medicare (HMO SNP) Plan Number H STAR RATING = 4 out of 5 stars Allwell by Health Net allwell.healthnetadvantage.com/ Must be eligible for Medicare and AHCCCS health plan Premiums, co-pays and coinsurance will be paid by AHCCCS Providers must have contract with Bridgeway ALTCS plan Additional Monthly Premium for this plan $0.00 Inpatient Hospital Skilled Nursing Facility Outpatient Mental Health Emergency/Urgent Care Co-pay per hospital emergency room visit for urgent care Ambulance Services Co-pay per trip Physician Services Co-pay for Primary Care Physician Co-pay for Specialist Physical, Occupational, Speech Therapy Routine Podiatry Service Chiropractic Care Diagnostic Tests, X-Rays, and Lab Services Clinical/diagnostic lab service Outpatient Services Facility co-pay at ambulatory surgical center Facility co-pay per outpatient hospital facility visit Prescription Drugs $ $3.70 Home Health Care Durable Medical Equipment (DME) Co-pay per item for Diabetic supplies Co-pay per piece of equipment Co-pay per prosthetic device Vision Services Co-pay per Medicare covered eye exam $0.00 Co-pay per annual vision exam $0.00 Frames/lenses/contacts $250 annual limit Hearing Services Co-pay for Medicare covered hearing exam $0.00 Co-pay for annual hearing exam $0.00 Hearing aid appliance (only one) $1,200 limit every three years Transportation Not Covered Dental Annual benefit Up to $1,
4 Allwell Dual Medicare (HMO SNP) Are my doctors in this plan s network? Yes No Is my pharmacy in the plan s network? Check with plan for over-the-counter benefits
5 Care1st+ (HMO SNP) Plan Number H STAR RATING = 3.5 stars out of Care 1 st Health Plan of AZ care1st.com/az/medicare Must be eligible for Medicare and AHCCCS health plan Premiums, co-pays and coinsurance will be paid by AHCCCS Providers must have contract with Care 1st AHCCCS plan Additional Monthly Premium for this plan $0.00 Inpatient Hospital Skilled Nursing Facility Outpatient Mental Health Emergency/Urgent Care Co-pay per hospital emergency room visit for urgent care Ambulance Services Co-pay per trip Physician Services Co-pay for Primary Care Physician Co-pay for Specialist Physical, Occupational, Speech Therapy Routine Podiatry Service Chiropractic Care Diagnostic Tests, X-Rays, and Lab Services Clinical/diagnostic lab service Outpatient Services Facility co-pay at ambulatory surgical center Facility co-pay per outpatient hospital facility visit Prescription Drugs $ $3.70 Home Health Care Durable Medical Equipment (DME) Co-pay per item for Diabetic supplies Co-pay per piece of equipment Co-pay per prosthetic device Vision Services Co-pay per Medicare covered eye exam $0.00 Co-pay per annual vision exam $0.00 Frames/lenses/contacts $350 annual limit Hearing Services Co-pay for Medicare covered hearing exam $0.00 Co-pay for annual hearing exam $0.00 Hearing aid appliance benefit $1,200 limit every three years Transportation (10 one way trips for added benefits such as dental, $0.00 vision, and hearing) Dental Annual benefit Up to $1,250
6 Care1st+ (HMO SNP) Are my doctors in this plan s network? Yes No Is my pharmacy in the plan s network? Check with plan for over-the-counter benefits
7 Health Choice Generations (HMO SNP) Plan Number H STAR RATING = 3 out of 5 stars Health Choice healthchoicegenerations.com Must be eligible for Medicare and be enrolled in an AHCCCS health plan Premiums, co-pays and coinsurance will be paid by AHCCCS Providers must have contract with Health Choice AHCCCS plan Additional Monthly Premium for this plan $0.00 Inpatient Hospital Skilled Nursing Facility Outpatient Mental Health Emergency/Urgent Care Co-pay per hospital emergency room visit for urgent care Ambulance Services Co-pay per trip Physician Services Co-pay for Primary Care Physician Co-pay for Specialist Physical, Occupational, Speech Therapy Routine Podiatry Service Chiropractic Care Diagnostic Tests, X-Rays, and Lab Services Clinical/diagnostic lab service Outpatient Services Facility co-pay at ambulatory surgical center Facility co-pay per outpatient hospital facility visit Prescription Drugs $ $3.70 Home Health Care Durable Medical Equipment (DME) Co-pay per item for Diabetic supplies Co-pay per piece of equipment Co-pay per prosthetic device Vision Services Co-pay per Medicare covered eye exam $0.00 Co-pay per annual vision exam $0.00 Frames/lenses/contacts benefit $300 annual limit Hearing Services Co-pay for Medicare covered hearing exam $0.00 Co-pay for annual hearing exam $0.00 Hearing aid appliance (only one) $1,500 limit every three years Transportation $0 Dental Annual benefit Up to $2,
8 Health Choice Generations (HMO SNP) Are my doctors in this plan s network? Yes No Is my pharmacy in the plan s network? Check with plan for over-the-counter benefits
9 Mercy Care Advantage (HMO SNP) Plan Number H STAR RATING = 3.5 out of 5 stars Mercy Care Advantage mercycareplan.com Must be eligible for Medicare and be enrolled in an AHCCCS health plan Premiums, co-pays and coinsurance will be paid by AHCCCS Providers must have contract with Mercy Care AHCCCS plan Additional Monthly Premium for this plan $0.00 Inpatient Hospital Skilled Nursing Facility Outpatient Mental Health Emergency/Urgent Care Co-pay per hospital emergency room visit for urgent care Ambulance Services Co-pay per trip Physician Services Co-pay for Primary Care Physician Co-pay for Specialist Physical, Occupational, Speech Therapy Routine Podiatry Service Chiropractic Care Diagnostic Tests, X-Rays, and Lab Services Clinical/diagnostic lab service Outpatient Services Facility co-pay at ambulatory surgical center Facility co-pay per outpatient hospital facility visit Prescription Drugs $ $3.70 Home Health Care Durable Medical Equipment (DME) Co-pay per item for Diabetic supplies Co-pay per piece of equipment Co-pay per prosthetic device Vision Services Co-pay per Medicare covered eye exam $0.00 Co-pay per annual vision exam $0.00 Benefit for frames/lenses/contacts $275 annual limit Hearing Services Co-pay for Medicare covered hearing exam $0.00 Co-pay for annual hearing exam $0.00 Hearing aid appliance benefit $1,700 limit every three years Transportation (cover up to 24-one way trips or 12-round trips for added $0.00 benefits such as chiropractic, dental, hearing aids, podiatry, vision) Dental Annual benefit Up to $3,000
10 Mercy Care Advantage (HMO SNP) Are my doctors in this plan s network? Yes No Is my pharmacy in the plan s network? Check with plan for over-the-counter benefits
11 United Healthcare Dual Complete (HMO SNP) Plan Number H STAR RATING = 3.5 out of 5 stars UHC Community Plan UHCdualcomplete.com Must be eligible for Medicare and AHCCCS health plan Premiums, co-pays and coinsurance will be paid by AHCCCS Providers must have contract with United Healthcare/APIPA AHCCCS plan Monthly Premium for this plan $0.00 Inpatient Hospital Skilled Nursing Facility Outpatient Mental Health Emergency/Urgent Care Co-pay per hospital emergency room visit for urgent care Ambulance Services Co-pay per trip Physician Services Co-pay for Primary Care Physician Co-pay for Specialist Physical, Occupational, Speech Therapy Routine Podiatry Service Chiropractic Care Diagnostic Tests, X-Rays, and Lab Services Clinical/diagnostic lab service Outpatient Services Facility co-pay at ambulatory surgical center Facility co-pay per outpatient hospital facility visit Prescription Drugs $ $3.70 Home Health Care Durable Medical Equipment (DME) Co-pay per item for Diabetic supplies Co-pay per piece of equipment Co-pay per prosthetic device Vision Services Co-pay per Medicare covered eye exam $0.00 Co-pay per annual vision exam $0.00 Benefit for frames/lenses/contacts $200 limit every two yrs Hearing Services Co-pay for Medicare covered hearing exam $0.00 Co-pay for annual hearing exam $0.00 Hearing aid appliance benefit $1,750 limit every two years Transportation (24-one way trips for added benefits such as dental, vision, $0.00 podiatry or hearing services) Dental Annual benefit Up to $3,
12 United Healthcare Dual Complete (HMO SNP) Are my doctors in this plan s network? Yes No Is my pharmacy in the plan s network? Check with plan for over-the-counter benefits
13 United Healthcare Dual Complete ONE (HMO SNP) Plan Number H STAR RATING = 3.5 out of 5 stars UHC Community Plan UHCdualcomplete.com CLIENT MUST BE ON ALTCS Premiums, co-pays and coinsurance will be paid by AHCCCS Providers must have contract with United Healthcare/APIPA AHCCCS plan Additional Monthly Premium for this plan $0.00 Inpatient Hospital Skilled Nursing Facility Outpatient Mental Health Emergency/Urgent Care Co-pay per hospital emergency room visit for urgent care Ambulance Services Co-pay per trip Physician Services Co-pay for Primary Care Physician Co-pay for Specialist Physical, Occupational, Speech Therapy Routine Podiatry Service Chiropractic Care Diagnostic Tests, X-Rays, and Lab Services Clinical/diagnostic lab service Outpatient Services Facility co-pay at ambulatory surgical center Facility co-pay per outpatient hospital facility visit Prescription Drugs $ $3.70 Home Health Care Durable Medical Equipment (DME) Co-pay per item for Diabetic supplies Co-pay per piece of equipment Co-pay per prosthetic device Vision Services Co-pay per Medicare covered eye exam $0.00 Co-pay per annual vision exam $0.00 Benefit for frames/lenses/contacts (every two years) $225 limit every two years Hearing Services Co-pay for Medicare covered hearing exam $0.00 Co-pay for annual hearing exam $0.00 Hearing aid appliance benefit $2000 limit every two years Transportation (24-one way trips for added benefits such as dental, vision, $0.00 podiatry or hearing services) Dental Annual benefit Up to $3,
14 United Healthcare Dual Complete ONE (HMO SNP) Are my doctors in this plan s network? Yes No Is my pharmacy in the plan s network? Check with plan for over-the-counter benefits
15 University Care Advantage (HMO SNP) University Care Advantage Plan Number: H STAR RATING = 3.5 out of 5 stars uahealthplans.com CLIENT MUST BE ON ALTCS Premiums, co-pays and coinsurance will be paid by AHCCCS Providers must have contract with Banner University Family Care plan Additional Monthly Premium for this plan $0.00 Inpatient Hospital Skilled Nursing Facility Outpatient Mental Health Emergency/Urgent Care Co-pay per hospital emergency room visit for urgent care Ambulance Services Co-pay per trip Physician Services Co-pay for Primary Care Physician Co-pay for Specialist Physical, Occupational, Speech Therapy Routine Podiatry Service Chiropractic Care Diagnostic Tests, X-Rays, and Lab Services Clinical/diagnostic lab service Outpatient Services Facility co-pay at ambulatory surgical center Facility co-pay per outpatient hospital facility visit Prescription Drugs $ $3.70 Home Health Care Durable Medical Equipment (DME) Co-pay per item for Diabetic supplies Co-pay per piece of equipment Co-pay per prosthetic device Vision Services Co-pay per Medicare covered eye exam $0.00 Co-pay per annual vision exam $0.00 Benefit for frames/lenses/contacts $200 limit every two years Hearing Services Co-pay for Medicare covered hearing exam $0.00 Co-pay for annual hearing exam $0.00 Hearing aid appliance benefit $1,500 limit every 3 years Transportation Not covered Dental Annual benefit Up to $2,
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This Summary of Benefits contains 2018 plan information for: Geisinger Gold Secure Rx (HMO SNP) For full details of services and costs for each plan, please consult the Evidence of Coverage at GeisingerGold.com
2018 Summary of Benefits
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Our service area includes the following county in: Florida: Miami-Dade.
2018 SUMMARY OF BENEFITS Overview of your plan Medica HealthCare Plans MedicareMax (HMO) H5420-001 Look inside to learn more about the health services and drug coverages the plan provides. Call Customer
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The maximum out-of-pocket limit applies to all covered Medicare Part A and B benefits including deductible. Primary Care Physician Selection Optional There is no requirement for member pre-certification.
EXCLUSIVE CARE SUMMARY OF COVERED BENEFITS Select Medicare Eligible Supplement Plan
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Our service area includes these counties in:
2018 SUMMARY OF BENEFITS Overview of your plan UnitedHealthcare Dual Complete (HMO SNP) H5008-010 Look inside to learn more about the health services and drug coverages the plan provides. Call Customer
PROFESSIONAL SERVICES INPATIENT HOSPITAL SERVICES OUTPATIENT FACILITY SERVICES
PROFESSIONAL SERVICES PCP office visits Specialist office visits Annual physical exam/preventive care Physical, Speech & Occupational Therapy Cardiac/Pulmonary Rehab Flu & Pneumonia Vaccinations Diagnostic
The HMO provider network is available by clicking on this website address: Plan Provider Directory Search<b/>
GENERAL PROVISIONS Web Site Address Find a Plan Doctor or Facility Health Plan Telephone Number NCQA Accreditation Status http://www.bcbsil.com The HMO provider network is available by clicking on this
Blue Choice. Hospital/$50, Physician's Office/Lesser of $50 or 20%; physician $40, facility $50. $35/trip $100/trip $50/trip $100/trip $100/trip
HOSPITAL SERVICES Hospital Inpatient : Paid in full No cost No cost No cost No cost Hospital Outpatient Hospital $40 or $60 per visit, : $20 per visit Hospital/$50, Physician's Office/Lesser of $50 or
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Our service area includes these counties in:
2018 SUMMARY OF BENEFITS Overview of your plan UnitedHealthcare Dual Complete LP1 (HMO SNP) H3794-002 Look inside to learn more about the health services and drug coverages the plan provides. Call Customer
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