PARTCRX

Plan Summary

Insurance Type
Medicare Advantage Plan (Part C w/ RX)
Insurance Provider
Coventry Health Care
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:
2014
Optional Supplemental Benefits?
No
Choice of Doctors?
Plan Doctors Only
Prescription Drugs Covered?
Yes
Out-Of-Pocket Spending Limit
$2,900 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
$5 maximum per visit
Not Applicable
Specialist Office Visit
$25 maximum per visit
Not Applicable
Outpatient Services
20% maximum per visit
Not Applicable
Emergency Care
$65 maximum per visit
Not Applicable
Ambulance Services
$250 maximum
Not Applicable
Kidney Disease and Conditions
20% maximum per visit
Not Applicable
Home Health Care
$0
Not Applicable
Durable Medical Equipment
20% maximum per item
Not Applicable
Inpatient Hospital Care
Days 1-9: $235 copay per day. Days 10-90: $0 copay per day
Not Applicable
Skilled Nursing Facility (SNF)
Days 1-20: $50 copay per day. Days 21-100: $150 copay per day
Not Applicable
Inpatient Mental Health Care
Days 1-9: $190 copay per day. Days 10-90: $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$2 copay$5 copay$2 copay
Tier 2: Non-Preferred Generic$4 copay$7 copay$4 copay
Tier 3: Preferred Brand Name$40 copay$43 copay$40 copay
Tier 4: Non-Preferred Brand Name$80 copay$83 copay$80 copay
Tier 5: Specialty Tier33% coinsurance33% coinsuranceNot offered
90 Day SupplyPreferred Retail PharmaciesNon-Preferred Retail PharmaciesMail-Order Pharmacies
Tier 1: Preferred Generic$6 copay$15 copay$6 copay
Tier 2: Non-Preferred Generic$12 copay$21 copay$12 copay
Tier 3: Preferred Brand Name$120 copay$129 copay$120 copay
Tier 4: Non-Preferred Brand Name$240 copay$249 copay$240 copay
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
Not Rated

Physician Finder

Physicians that accept Coventry Total Care (HMO) for Iowa

/
NUTT, GARY
2802 E EUCLID AVE
DES MOINES, IA 50317
PERCY-SWEET, JEAN
2918 E UNIVERSITY AVE
DES MOINES, IA 50317
VAN WYK, ALEXANDER
2915 HUBBELL AVE
DES MOINES, IA 50317
AGUILAR, JOSE
1350 DES MOINES ST.
DES MOINES, IA 50309
YOUNT, DAVID
2459 E EUCLID AVE
DES MOINES, IA 50317
WEBB, KRISTA
3400 E 33RD ST
DES MOINES, IA 50317
RODRIGUEZ, CARLOS
1250 E 9TH ST
DES MOINES, IA 50316
PENISTEN, SCOTT
1105 N ANKENY BLVD STE 100
ANKENY, IA 50023
PALAKURTHY, PRASAD
1301 PENN AVE
DES MOINES, IA 50316
NATH, AMAR
1301 PENN AVENUE
DES MOINES, IA 50316
STEVENS, CRAIG
1301 PENN AVENUE
DES MOINES, IA 50316
BUNTING, TERRI
1301 PENN AVENUE
DES MOINES, IA 50316
HART, TIMOTHY
1301 PENN AVE
DES MOINES, IA 50316
KESHWANI, ANISH
840 E UNIVERSITY AVE
DES MOINES, IA 50316
RICHARDS, L
1301 PENN AVE
DES MOINES, IA 50316
MITCHELL, MARIA
2301 E 14TH ST
DES MOINES, IA 50316
LACHENMAIER, REBECCA
1215 PLEASANT ST
DES MOINES, IA 50309
SIDNEY, REBECCA
1201 PENNSYLVANIA AVE
DES MOINES, IA 50316
BERRY, GREGORY
1201 PENNSYLVANIA AVE
DES MOINES, IA 50316
VITTETOE, DAVID
1301 PENN AVE
DES MOINES, IA 50316
LIN, IAN
1301 PENN AVE
DES MOINES, IA 50316
VAUDT, CORY
1301 PENNSYLVANIA AVE STE 417
DES MOINES, IA 50316
ABBASI, JAVAID
1301 PENNSYLVANIA AVE
DES MOINES, IA 50316
NICHOLS, JEFF
700 E UNIVERSITY AVE
DES MOINES, IA 50316
REHMANN, JOSHUA
840 E UNIVERSITY AVE
DES MOINES, IA 50316
Details
GARY NUTT
Phone Number
(515) 263-0444
Office Locations
2802 E EUCLID AVE
DES MOINES, IA 50317
2802 E EUCLID AVE DES MOINES IA, 50317

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