PARTCRX

Plan Summary

Insurance Type
Medicare Advantage Plan (Part C w/ RX)
Insurance Provider
Florida Healthcare Plus
CMS Rating
Not Rated
Plan Type
HMO
Annual Drug 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
$3,400 In-Network
Other Deductibles?
In Network: No. Out of Network: No
Health Plan Deductible
$0
Monthly Drug Plan Premium
$0.00
Monthly Health Plan Premium
$0.00

Benefits

Service
In Network
Out of Network
Doctor Office Visits
$0
Not Applicable
Specialist Office Visit
$10 maximum per visit
Not Applicable
Outpatient Services
$100 maximum per visit
Not Applicable
Emergency Care
$50 maximum per visit
Not Applicable
Ambulance Services
$75 maximum
Not Applicable
Kidney Disease and Conditions
20% maximum per visit
Not Applicable
Home Health Care
$0
Not Applicable
Durable Medical Equipment
$0
Not Applicable
Inpatient Hospital Care
Days 1-5: $50 copay per day. Days 6-90: $0 copay per day
Not Applicable
Skilled Nursing Facility (SNF)
Days 1-5: $0 copay per day. Days 6-100: $50 copay per day
Not Applicable
Inpatient Mental Health Care
Days 1-5: $50 copay per day. Days 6-90: $0 copay per day
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$0 copay$0 copayNot offered
Tier 2: Non-Preferred Generic$10 copay$10 copayNot offered
Tier 3: Preferred Brand Name$40 copay$40 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$0 copay$0 copay$0 copay
Tier 2: Non-Preferred Generic$30 copay$30 copay$30 copay
Tier 3: Preferred Brand Name$120 copay$120 copay$120 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
Not Rated
Cholesterol screening for patients with heart disease
Not Rated
Glaucoma testing
Not Rated
Annual flu vaccine
Not Rated
Pneumonia vaccine
Not Rated
Improving or maintaining physical health
Not Rated
Improving or maintaining mental health
Not Rated
Monitoring physical ability
Not Rated
Access to primary care doctor visits
Not Rated
Adult BMI assessment
Not Rated

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
Not Rated
Diabetes care – eye exam
Not Rated
Diabetes care – kidney disease monitoring
Not Rated
Diabetes care – blood sugar controlled
Not Rated
Diabetes care – cholesterol controlled
Not Rated
Controlling blood pressure
Not Rated
Rheumatoid arthritis management
Not Rated
Improving bladder control
Not Rated
Reducing the risk of falling
Not Rated
Plan all-cause readmissions
Not Rated

Ratings of Plan Responsiveness and Care

Getting needed care
Not Rated
Getting appointments and care quickly
Not Rated
Customer service
Not Rated
Overall rating of health care quality
Not Rated
Overall rating of plan
Not Rated

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

Complaints about the health plan
Not Rated
Beneficiary access and performance problems
Members choosing to leave the plan
Not Rated
Plan makes timely decision about appeals
Not Rated
Reviewing appeals decisions
Not Rated
Call center – foreign language interpreter and TTY/TDD availability
Not Rated

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