PARTC

Plan Summary

Insurance Type
Medicare Advantage Plan (Part C)
Insurance Provider
Cigna-HealthSpring
CMS Rating
Plan Type
HMO
Annual Deductible
$0.00

What To Know About This Plan

  • This is a health coverage only plan with no drug coverage

Why We Like This Plan

  • has no additional premium costs outside of your Medicare Part B premium

All cost-sharing assumes in-network healthcare providers.

Plan Details

Costs and Other Important Information

Plan Year:
2016
Monthly Drug Plan Premium
Not Applicable
Health Plan Deductible
$0
Choice of Doctors?
Plan Doctors for Most Services
Monthly Health Plan Premium
$0.00
Out-Of-Pocket Spending Limit
$4,500 In-network
Optional Supplemental Benefits?
No
Prescription Drugs Covered?
No
Other Health Plan Deductibles?
No

Benefits

Service
Cost
Ambulance Services
$100 copay or 20% of the cost, depending on the service
Doctors Office Visits
Primary care physician visit: $10 copay
Specialist visit: $40 copay
Emergency Care
$75 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.
Home Health Care
You pay nothing
Mental Health Care
Inpatient visit:
Our plan covers up to 190 days in a lifetime for inpatient mental health care in
a psychiatric hospital. The inpatient hospital care limit does not apply to inpatient
mental services provided in a general hospital.
Our plan covers 90 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 90 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 90 days.
  • $275 copay per day for days 1 through 5

  • You pay nothing per day for days 6 through 90

  • Outpatient group therapy visit: $40 copay
    Outpatient individual therapy visit: $40 copay
    Outpatient hospital
    $300 per visit
    Renal dialysis
    $30 per visit
    Inpatient Hospital Care
    Our plan covers 90 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 90 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 90 days.
    · $250 copay per day for days 1 through 7
    · You pay nothing per day for days 8 through 90
    Diabetes Supplies and Services
    Diabetes monitoring supplies: 0-20% of the cost, depending on the supply
    Diabetes self-management training: You pay nothing
    Therapeutic shoes or inserts: 20% of the cost
    Acupuncture
    Not covered
    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.
    Outpatient Substance Abuse
    Group therapy visit: $40 copay
    Individual therapy visit: $40 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): You pay nothing
    Occupational therapy visit: $30 copay
    Physical therapy and speech and language therapy visit: $30 copay
    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.
    Transportation
    Not covered
    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): $0-200 copay,
    depending on the service
    Diagnostic tests and procedures: $0-200 copay, depending on the service
    Lab services: You pay nothing
    Outpatient x-rays: $25 copay
    Therapeutic radiology services (such as radiation treatment for cancer): $40 copay
    Over-the-Counter Items
    Not Covered
    Dental Services
    Limited dental services (this does not include services in connection with care,
    treatment, filling, removal, or replacement of teeth): $40 copay
    Vision Services
    Exam to diagnose and treat diseases and conditions of the eye (including
    yearly glaucoma screening): $0-40 copay, depending on the service
    Routine eye exam (for up to 1 every year): $0 copay
    Contact lenses: $0 copay
    Eyeglasses (frames and lenses) (for up to 1 every year): $0 copay
    Eyeglass frames (for up to 1 every year): $0 copay
    Eyeglass lenses (for up to 1 every year): $0 copay
    Eyeglasses or contact lenses after cataract surgery: $0 copay
    Our plan pays up to $100 every year for eyewear.
    $0 copays for supplemental eyewear (except after cataract surgery) apply up to the
    plan allowance. Please see your EOC for plan coverage details.
    Hearing Services
    Exam to diagnose and treat hearing and balance issues: $10-40 copay,
    depending on the service
    Prosthetic Devices (braces artificial limbs etc.)
    Prosthetic devices: 20% of the cost
    Related medical supplies: 20% of the cost
    Renal Dialysis
    $30 copay
    Outpatient Surgery
    Ambulatory surgical center: $200 copay
    Outpatient hospital: $300 copay
    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
    Foot Care
    Foot exams and treatment if you have diabetes-related nerve damage and/or
    meet certain conditions: $40 copay
    Urgent 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 urgently needed services. See the "Inpatient Hospital Care"
    section of this booklet for other costs.
    Skilled Nursing Facility
    Our plan covers up to 100 days in a SNF.
    · You pay nothing per day for days 1 through 20
    · $160 copay per day for days 21 through 100
    Durable Medical Equipment (wheelchairs oxygen etc.)
    20% of the cost

    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 Cigna-HealthSpring Advantage (HMO) for Illinois

    /
    THOMAS, ABRAHAM
    9125 S PULASKI RD
    EVERGREEN PARK, IL 60805
    Details
    ABRAHAM THOMAS, M.D.
    Phone Number
    (708) 422-7715
    Office Locations
    9125 S PULASKI RD
    EVERGREEN PARK, IL 60805
    9125 S PULASKI RD EVERGREEN PARK IL, 60805

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