PARTCRX

Plan Summary

Insurance Type
Medicare Advantage Plan (Part C w/ RX)
Insurance Provider
Blue Cross Blue Shield of Florida
CMS Rating
Plan Type
Regional PPO
Annual Deductible
$260.00

What To Know About This Plan

  • This plan has health and drug coverage

Why We Like This Plan

  • has both Health and Drug Coverage
  • gives you freedom to choose which doctors, specialist and hospitals you visit

All cost-sharing assumes in-network healthcare providers.

Plan Details

Costs and Other Important Information

Plan Year:
2016
Optional Supplemental Benefits?
No
Choice of Doctors?
Any Doctor
Prescription Drugs Covered?
Yes
Out-Of-Pocket Spending Limit
$10,000 In and Out-of-network $6,700 In-network $10,000 Out-of-network
Other Health Plan Deductibles?
No
Health Plan Deductible
$950 annual deductible
Monthly Drug Plan Premium
$13.40
Monthly Health Plan Premium
$26.50

Benefits

Service
Cost
Ambulance
In-network: $225
Out-of-network: $250
Doctor's office visits
Primary Physician
In-network: $15 per visit
Out-of-network: 50% per visit
Specialist
In-network: $50 per visit
Out-of-network: 50% per visit
Durable medical equipment (wheelchairs, oxygen, etc.)
In-network: 0-20% per item
Out-of-network: 50% per item
Emergency care
$75 per visit (always covered)
Home health care
In-network: You pay nothing
Out-of-network: 50%
Mental health care
In-network: $295 for days 1 through 5
$0 for days 6 through 90
Out-of-network: $495 for days 1 through 27
$0 for days 28 through 90
Outpatient hospital
In-network: 30% per visit
Out-of-network: 50% per visit
Renal dialysis
In-network: 20% per visit
Out-of-network: 20% per visit
Inpatient hospital care
In-network: $295 for days 1 through 5
$0 for days 6 through 90
$0 for days 91 and beyond
Out-of-network: $495 for days 1 through 27
$0 for days 28 through 90
Skilled Nursing Facility (SNF)
In-network: $0 for days 1 through 20
$160 for days 21 through 100
Out-of-network: $250 for days 1 through 58
$0 for days 59 through 100

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$10 copay$15 copay$10 copay
Tier 2: Non-Preferred Generic$15 copay$20 copay$15 copay
Tier 3: Preferred Brand Name$42 copay$47 copay$42 copay
Tier 4: Non-Preferred Brand Name$95 copay$100 copay$95 copay
Tier 5: Specialty Tier27% coinsurance27% coinsurance27% coinsurance
90 Day SupplyPreferred Retail PharmaciesNon-Preferred Retail PharmaciesMail-Order Pharmacies
Tier 1: Preferred Generic$30 copay$45 copay$30 copay
Tier 2: Non-Preferred Generic$45 copay$60 copay$45 copay
Tier 3: Preferred Brand Name$126 copay$141 copay$126 copay
Tier 4: Non-Preferred Brand Name$285 copay$300 copay$285 copay
Tier 5: Specialty Tier

CMS Ratings

Staying healthy - screenings, tests and vaccines

Breast cancer screening
Colorectal cancer screening
Annual flu vaccine
Improving or maintaining physical health
Improving or maintaining mental health
Monitoring physical ability
Adult BMI assessment

Managing Chronic Conditions

Special needs plan care management
Not Rated
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
Controlling blood pressure
Rheumatoid arthritis management
Reducing the risk of falling
Plan all-cause readmissions

Member Experience with Health Plan

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

Member Complaints, and Changes in Health Plan's Performance

Complaints about the health plan
Members choosing to leave the health plan
Beneficiary access and performance problems
Health plan quality improvement

Health Plan Customer Service

Plan makes timely decision about appeals
Reviewing appeals decisions
Call center – foreign language interpreter and TTY/TDD availability - Medical

Drug Plan Customer Service

Call center – foreign language interpreter and TTY/TDD availability - Drugs
Appeals auto-forward
Appeals upheld

Member Complaints, and Changes in Drug Plan's Performance

Complaints about the drug plan
Members choosing to leave the drug plan
Beneficiary access and performance problems
Drug plan quality improvement

Member Experience with Drug Plan

Rating of drug plan
Getting needed prescription drugs

Drug Pricing and Patient Safety

MPF Price Accuracy
High risk medication
Part D medication adherence for diabetes
Part D medication adherence for hypertension
Part D medication adherence for cholesterol
Medication Therapy Management program completion rate

Physician Finder

Physicians that accept BlueMedicare Regional PPO (Regional PPO) for Florida

/
MEZEY, ROBERT
12600 SW 120TH ST
MIAMI, FL 33186
HERRERA, MAURICIO
11801 SW 90TH ST
MIAMI, FL 33186
SCHNEIDER, JESSICA
12608 SW 88TH ST
MIAMI, FL 33186
MCCARTHY, LIAM
11801 SW 90TH ST
MIAMI, FL 33186
GARCIA-ORTIZ, SANDRA
11435 SW 133RD CT APT 3
MIAMI, FL 33186
HERNANDEZ, OSCAR
14221 SW 120TH ST
MIAMI, FL 33186
ESPINOSA, CARMEN
13550 SW 88TH STREET STE 280
MIAMI, FL 33186
JIMENEZ, MILTON
12002 SW 128TH CT STE 204
MIAMI, FL 33186
KADE, KAREN
12600 SW 120TH ST
MIAMI, FL 33186
MURO, THOMAS
13550 SW 120TH ST
MIAMI, FL 33186
APOLLON, KATIA
8900 SW 117TH AVE
MIAMI, FL 33186
GERSTEN, JANET
8900 SW 117TH AVE
MIAMI, FL 33186
PONS, FRANCISCO
13500 SW 88TH ST
MIAMI, FL 33186
SHAH, CHANDRAKANT
13033 SW 112TH ST
MIAMI, FL 33186
BUIA, MONTSERRAT
11801 SW 90TH ST
MIAMI, FL 33186
DR WENTWORTH JARRETT PA
12955 SW 132ND ST
MIAMI, FL 33186
RODICIO, ILEANA
9000 SW 137TH AVE
MIAMI, FL 33186
NUNEZ, RIGOBERTO
8900 SW 117TH AVE
MIAMI, FL 33186
GOMEZ, MANUEL
13000 SW 117 STREET
MIAMI, FL 33186
GOYKHMAN, GARY
11801 SW 90TH ST
MIAMI, FL 33186
GUPTA, PADMA
13500 SW 88TH ST
MIAMI, FL 33186
CINTAS, MAURA
9000 SW 137TH AVE
MIAMI, FL 33186
MAYORGA, RENE
14261 SW 120TH ST STE 110
MIAMI, FL 33186
PELAEZ, ANNETTE
8900 SW 117TH AVE
MIAMI, FL 33186
RAJADHYAKSHA, AMAR
11801 SW 90TH ST
MIAMI, FL 33186
Details
ROBERT MEZEY, M.D., F.C.C.P.
Phone Number
(305) 255-0777
Office Locations
12600 SW 120TH ST
MIAMI, FL 33186
12600 SW 120TH ST MIAMI FL, 33186

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