PARTCRX

Plan Summary

Insurance Type
Medicare Advantage Plan (Part C w/ RX)
Insurance Provider
Excellus
CMS Rating
Plan Type
HMO
Annual Deductible
$0.00

What To Know About This Plan

  • This plan has health and drug coverage

Plan Details

Costs and Other Important Information

Plan Year:
2013
Optional Supplemental Benefits?
No
Choice of Doctors?
Plan Doctors Only
Prescription Drugs Covered?
Yes
Out-Of-Pocket Spending Limit
$3,800 In-Network
Other Deductibles?
In Network: No. Out of Network: No
Health Plan Deductible
$0
Monthly Drug Plan Premium
$43.10
Monthly Health Plan Premium
$30.90

Benefits

Service
In Network
Out of Network
Doctor Office Visits
$10 maximum per visit
Not Applicable
Specialist Office Visit
$40 maximum per visit
Not Applicable
Outpatient Services
$125 maximum per visit
Not Applicable
Emergency Care
$65 maximum per visit
Not Applicable
Ambulance Services
$150 maximum
Not Applicable
Kidney Disease and Conditions
$0
Not Applicable
Home Health Care
$0
Not Applicable
Durable Medical Equipment
20% maximum per item
Not Applicable
Inpatient Hospital Care
$375 copay
Not Applicable
Skilled Nursing Facility (SNF)
Days 1-100: $50 copay per day
Not Applicable
Inpatient Mental Health Care
$375 copay
Not Applicable

Cost Sharing Information

Prescription Drug Copay/Coninsurance Details - Initial Coverage Limit

30 Day SupplyPreferred Retail PharmaciesNon-Preferred Retail PharmaciesMail-Order Pharmacies
Tier 1: Preferred Generic$3 copay$3 copayNot offered
Tier 2: Non-Preferred Generic$40 copay$40 copayNot offered
Tier 3: Preferred Brand Name$90 copay$90 copayNot offered
Tier 4: Non-Preferred Brand Name33% coinsurance33% coinsuranceNot offered
Tier 5: Specialty Tier
90 Day SupplyPreferred Retail PharmaciesNon-Preferred Retail PharmaciesMail-Order Pharmacies
Tier 1: Preferred Generic$7.5 copay$7.5 copay$7.5 copay
Tier 2: Non-Preferred Generic$100 copay$100 copay$100 copay
Tier 3: Preferred Brand Name$225 copay$225 copay$225 copay
Tier 4: Non-Preferred Brand Name33% coinsurance33% coinsurance33% coinsurance
Tier 5: Specialty Tier

CMS Ratings

Staying healthy - screenings, tests and vaccines

Breast cancer screening
Not Rated
Colorectal cancer screening
Cholesterol screening for patients with heart disease
Glaucoma testing
Annual flu vaccine
Pneumonia vaccine
Improving or maintaining physical health
Improving or maintaining mental health
Monitoring physical ability
Access to primary care doctor visits
Adult BMI assessment

Managing Chronic Conditions

Care for older adults – medication review
Not Rated
Care for older adults – functional status assessment
Not Rated
Care for older adults – Pain screening
Not Rated
Osteoporosis management in women who had a fracture
Diabetes care – eye exam
Diabetes care – kidney disease monitoring
Diabetes care – blood sugar controlled
Diabetes care – cholesterol controlled
Controlling blood pressure
Rheumatoid arthritis management
Improving bladder control
Reducing the risk of falling
Plan all-cause readmissions

Ratings of Plan Responsiveness and Care

Getting needed care
Getting appointments and care quickly
Customer service
Overall rating of health care quality
Overall rating of plan

Member Complaints, Problems Getting Services, and Choosing to Leave the Plan

Complaints about the health plan
Beneficiary access and performance problems
Members choosing to leave the plan
Plan makes timely decision about appeals
Reviewing appeals decisions
Call center – foreign language interpreter and TTY/TDD availability

Physician Finder

Physicians that accept Medicare Blue Choice Value Plus (HMO) for New York

/
CHENG, ERIC
3309 CHURCH AVE
BROOKLYN, NY 11203
GLEITMAN, DAVID
1532 FLATBUSH AVE
BROOKLYN, NY 11210
CADAG, RAMIRO
1497 OCEAN PKWY
BROOKLYN, NY 11230
ARONICA, FRANK
20 PLAZA ST E
BROOKLYN, NY 11238
AHAMED, JAHID
55 GREENE AVENUE
BROOKLYN, NY 11238
PAONE, THOMAS
506 SIXTH STREET
BROOKLYN, NY 11215
PATRICE, GEOFFROY
914 E 84TH ST
BROOKLYN, NY 11236
TIO, RUY
1715 EAST 17TH STREET
BROOKLYN, NY 11229
ETKIN, ALEXANDRA
1302 KINGS HWY
BROOKLYN, NY 11229
RASKIN, SIMON
1409 GRAVESEND NECK RD
BROOKLYN, NY 11229
CIANCIMINO, ALBERT
335 COURT ST
BROOKLYN, NY 11231
ALZOOBAEE, FAIZ
6805 5TH AVE
BROOKLYN, NY 11220
BAY PODIATRY ASSOCIATES,PLLC
8607 21ST AVE
BROOKLYN, NY 11214
LYON, THOMAS
9711 3RD AVE
BROOKLYN, NY 11228
CHARI, RAGINI
670 92ND ST
BROOKLYN, NY 11228
MIR, MOHAMMAD
365 STOCKHOLM ST
BROOKLYN, NY 11237
Details
ERIC CHENG, MD
Phone Number
(718) 856-3100
Office Locations
3309 CHURCH AVE
BROOKLYN, NY 11203
3309 CHURCH AVE BROOKLYN NY, 11203

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