PARTCRX

Plan Summary

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

What To Know About This Plan

  • This plan has health and drug coverage

Why We Like This Plan

  • has both Health and Drug Coverage
  • has a copay of $0 for Tier 1 preferred generic drugs (30 day supply, preferred retail pharmacies)

All cost-sharing assumes in-network healthcare providers.

Plan Details

Costs and Other Important Information

Plan Year:
2016
Optional Supplemental Benefits?
Yes
Choice of Doctors?
Plan Doctors for Most Services
Prescription Drugs Covered?
Yes
Out-Of-Pocket Spending Limit
$3,400 In-network
Other Health Plan Deductibles?
No
Health Plan Deductible
$0
Monthly Drug Plan Premium
$45.00
Monthly Health Plan Premium
$4.00

Benefits

Service
Cost
Ambulance Services
$195 copay
Doctors Office Visits
Primary care physician visit: You pay nothing
Specialist visit: $0-$20 copay, depending on the service
You pay a $0 copay for Medicare-covered specialist services
received through CareMore Care Center Programs.
You pay $20 copay for each visit for Medicare-covered
specialist services received in a network provider's office.
Emergency Care
$65 copay
If you are admitted to the hospital within 24 hours, you do
not have to pay your share of the cost for emergency care. See
the "Inpatient Hospital Care" section of this booklet for other
costs.
$10,000 plan coverage limit for supplemental emergency
services outside the U.S. and its territories every year.
If you are admitted to the hospital within 24-hour(s) for the
same condition, you pay $0 for the emergency room visit.
Home Health Care
You pay nothing
Mental Health Care
Inpatient visit:
The copays for hospital and skilled nursing facility (SNF)
benefits are based on benefit periods. A benefit period begins
the day you're admitted as an inpatient and ends when you
haven't received any inpatient care (or skilled care in a SNF)
for 60 days in a row. If you go into a hospital or a SNF after
one benefit period has ended, a new benefit period begins.
You must pay the inpatient hospital deductible for each benefit
period. There's no limit to the number of benefit periods.
Our plan covers 150 days for an inpatient hospital stay.
Our plan also covers 60 "lifetime reserve days." These are
"extra" days that we cover. If your hospital stay is longer than
150 days, you can use these extra days. But once you have
used up these extra 60 days, your inpatient hospital coverage
will be limited to 150 days.
$100 copay per day for days 1 through 5
You pay nothing per day for days 6 through 90
You pay nothing per day for days 91 through 150
Outpatient group therapy visit: $0-$20 copay, depending on
the service
Outpatient individual therapy visit: $0-$20 copay, depending
on the service
For Medicare-covered outpatient mental health care services,
you pay:
$0 copay for care recieved in CareMore Care Centers and
CareMore Behavioral Health Centers.
$20 copay for each visit to a network mental health provider's
office.
$20 copay for each visit to a network psychiatrist's office.
Outpatient hospital
$100 per visit
Renal dialysis
You pay nothing
Inpatient Hospital Care
The copays for hospital and skilled nursing facility (SNF)
benefits are based on benefit periods. A benefit period begins
the day you're admitted as an inpatient and ends when you
haven't received any inpatient care (or skilled care in a SNF)
for 60 days in a row. If you go into a hospital or a SNF after
one benefit period has ended, a new benefit period begins.
You must pay the inpatient hospital deductible for each benefit
period. There's no limit to the number of benefit periods.
Our plan covers 95 days for an inpatient hospital stay.
Our plan also covers 60 "lifetime reserve days." These are
"extra" days that we cover. If your hospital stay is longer than
95 days, you can use these extra days. But once you have used
up these extra 60 days, your inpatient hospital coverage will
be limited to 95 days.
$100 copay per day for days 1 through 5
You pay nothing per day for days 6 through 90
You pay nothing per day for days 91 through 95
Acupuncture
Not covered
Chiropractic Care
Manipulation of the spine to correct a subluxation (when 1
or more of the bones of your spine move out of position):
$20 copay
Dental Services
Limited dental services (this does not include services in
connection with care, treatment, filling, removal, or
replacement of teeth): $0-$20 copay, depending on the service
Diabetes Supplies and Services
Diabetes monitoring supplies: 20% of the cost
Diabetes self-management training: You pay nothing
Therapeutic shoes or inserts: $50 copay
Diabetic Supplies and Services are limited to specific
manufacturers, products and/or brands. Contact the plan for
a list of covered supplies.
Diagnostic Tests, Lab and Radiology Services, and X-Rays (Costs for these services may vary based on place of service)
Diagnostic radiology services (such as MRIs, CT scans):
$0-$150 copay, depending on the service
Diagnostic tests and procedures: You pay nothing
Lab services: You pay nothing
Outpatient x-rays: You pay nothing
Therapeutic radiology services (such as radiation treatment
for cancer): 20% of the cost
Hearing Services
Exam to diagnose and treat hearing and balance issues: $0
copay
Routine hearing exam (for up to 1 every year): $0 copay
Hearing aid fitting/evaluation (for up to 1 every year): $0
copay
Outpatient Rehabilitation
Cardiac (heart) rehab services (for a maximum of 2 one-hour
sessions per day for up to 36 sessions up to 36 weeks): $20
copay
Occupational therapy visit: $20 copay
Physical therapy and speech and language therapy visit:
$0-$20 copay, depending on the service
You pay a $20 copay for each visit for Medicare-covered
occupational or speech language therapy services.
You pay a $0 copay for Medicare-covered physical therapy
through CareMore Care Center programs.
Outpatient Substance Abuse
Group therapy visit: $30 copay
Individual therapy visit: $30 copay
Outpatient Surgery
Ambulatory surgical center: $100 copay
Outpatient hospital: $100 copay
Over-the-Counter Items
Not Covered
Renal Dialysis
You pay nothing
Transportation
You pay nothing
General
Authorization rules may apply.
In-Network
$0 copay for trips to CareMore Care Centers for specific
services only.
Vision Services
Exam to diagnose and treat diseases and conditions of the eye
(including yearly glaucoma screening): $0-$20 copay,
depending on the service
Routine eye exam (for up to 1 every year): $0 copay
Contact lenses (for up to 1 every two years): $0 copay
Our plan pays up to $100 every two years for contact lenses.
Eyeglass frames (for up to 1 every two years): $0 copay
Our plan pays up to $100 every two years for eyeglass frames.
Eyeglass lenses (for up to 1 every two years): $20 copay
Eyeglasses or contact lenses after cataract surgery: $0 copay
Preventive Care
You pay nothing
Our plan covers many preventive services, including:
Abdominal aortic aneurysm screening
Alcohol misuse counseling
Bone mass measurement
Breast cancer screening (mammogram)
Cardiovascular disease (behavioral therapy)
Cardiovascular screenings
Cervical and vaginal cancer screening
Colorectal cancer screenings (Colonoscopy, Fecal occult
blood test, Flexible sigmoidoscopy)
Depression screening
Diabetes screenings
HIV screening
Medical nutrition therapy services
Obesity screening and counseling
Prostate cancer screenings (PSA)
Sexually transmitted infections screening and counseling
Tobacco use cessation counseling (counseling for people
with no sign of tobacco-related disease)
Vaccines, including Flu shots, Hepatitis B shots,
Pneumococcal shots
"Welcome to Medicare" preventive visit (one-time)
Yearly "Wellness" visit
Any additional preventive services approved by Medicare
during the contract year will be covered.
Hospice
You pay nothing for hospice care from a Medicare-certified
hospice. You may have to pay part of the cost for drugs and
respite care. Hospice is covered outside of our plan. Please
contact us for more details.
Durable Medical Equipment
0%-20% of the cost, depending on the equipment
You pay 0% of the total cost when the purchase or rental price
of the Medicare-covered durable medical equipment and
related supplies is $0-$499 per item.
You pay 20% of the total cost when the purchase or rental
price of the Medicare-covered durable medical equipment
and related supplies is $500 or greater per item.
Foot Care
Foot exams and treatment if you have diabetes-related nerve
damage and/or meet certain conditions: $0-$20 copay,
depending on the service
Routine foot care (for up to 6 visit(s) every year): $0-$20
copay, depending on the service
You pay a $0 copay for each visit for Medicare-covered
podiatry (medically necessary) and routine foot care services
received through CareMore Care Center programs.
You pay a $20 copay for each visit for Medicare-covered
podiatry (medically necessary) and routine foot care services
received in a network provider's office.
Urgent Care
$20 copay
Skilled Nursing Facility
Our plan covers up to 100 days in a SNF.
You pay nothing per day for days 1 through 20
$100 copay per day for days 21 through 100
No prior hospital stay required.
Prosthetic Devices
Prosthetic devices: 0%-20% of the cost, depending on the
device
Related medical supplies: 0%-20% of the cost, depending on
the supply
You pay 0% of the total cost when the purchase or rental price
of the Medicare-covered prosthetic devices and related supplies
is $0–$499 per item.
You pay 20% of the total cost when the purchase or rental
price of the Medicare-covered prosthetic devices and related
supplies is $500 or greater per item.

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$5 copayNot offered
Tier 2: Non-Preferred Generic$7.5 copay$12.5 copayNot offered
Tier 3: Preferred Brand Name$40 copay$45 copayNot offered
Tier 4: Non-Preferred Brand Name$85 copay$95 copayNot offered
Tier 5: Specialty Tier33% coinsurance33% coinsurance33% coinsurance
90 Day SupplyPreferred Retail PharmaciesNon-Preferred Retail PharmaciesMail-Order Pharmacies
Tier 1: Preferred Generic$0 copay$15 copay$0 copay
Tier 2: Non-Preferred Generic$22.5 copay$37.5 copay$18.75 copay
Tier 3: Preferred Brand Name$120 copay$135 copay$100 copay
Tier 4: Non-Preferred Brand Name$255 copay$285 copay$212.5 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
Care for older adults – medication review
Care for older adults – functional status assessment
Care for older adults – Pain screening
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
Not Rated

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 CareMore Value Plus (HMO) for California

/
JOSH LAGATTA DDS INC
1201 E FLORENCE AVE # B
LOS ANGELES, CA 90001
SOL SILBERSTEIN M.D. A MEDICAL CORPORATION
1127 WILSHIRE BLVD
LOS ANGELES, CA 90017
LADDARAN, BENITO
2105 BEVERLY BLVD
LOS ANGELES, CA 90057
SCOTT, DENA
10221 COMPTON AVENUE #203
LOS ANGELES, CA 90002
WALKER, DAPHNE
1520 SAN PABLO ST STE 1600
LOS ANGELES, CA 90033
TSAI, ARNOLD
1520 SAN PABLO ST
LOS ANGELES, CA 90033
YBPC MEDICAL CLINIC INC
1828 E CESAR E CHAVEZ AVE
LOS ANGELES, CA 90033
SMITH, ROBERT
601 S WESTMORELAND AVE
LOS ANGELES, CA 90005
Details
JOSH LAGATTA DDS INC
Phone Number
(562) 773-6057
Office Locations
1201 E FLORENCE AVE # B
LOS ANGELES, CA 90001
1201 E FLORENCE AVE # B LOS ANGELES CA, 90001

Similar Plans

PremiumPlan NameCMS Rating
from $0
Kaiser Permanente Senior Advantage B Only South (HMO)
Details
from $0
SCAN Classic (HMO)
Details
from $18
Humana Walmart Rx Plan (PDP)
Details
from $31
SilverScript Choice (PDP)
Details
from $0
Inter Valley Health Plan Service To Seniors (HMO)
Details

Related Articles

Related Searches

{}