PARTCRX

Plan Summary

Insurance Type
Medicare Advantage Plan (Part C w/ RX)
Insurance Provider
EmblemHealth
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 no additional premium costs outside of your Medicare Part B premium
  • 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?
No
Choice of Doctors?
Plan Doctors for Most Services
Prescription Drugs Covered?
Yes
Out-Of-Pocket Spending Limit
$6,700 In-network
Other Health Plan Deductibles?
No
Health Plan Deductible
$0
Monthly Drug Plan Premium
$0.00
Monthly Health Plan Premium
$0.00

Benefits

Service
Cost
Ambulance
$100
Doctor's office visits
Primary Physician
You pay nothing
Specialist
$23 per visit
Durable medical equipment (wheelchairs, oxygen, etc.)
20% per item
Emergency care
$75 per visit (always covered)
Home health care
You pay nothing
Mental health care
You pay nothing
Outpatient hospital
$0-350 per visit
Renal dialysis
20% per visit
Inpatient hospital care
$351 for days 1 through 5
$0 for days 6 through 90
Skilled Nursing Facility (SNF)
$0 for days 1 through 20
$160 for days 21 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$0 copay$0 copay$0 copay
Tier 2: Non-Preferred Generic$15 copay$15 copay$15 copay
Tier 3: Preferred Brand Name$47 copay$47 copay$47 copay
Tier 4: Non-Preferred Brand Name$100 copay$100 copay$100 copay
Tier 5: Specialty Tier25% coinsurance25% coinsurance25% coinsurance
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$45 copay$45 copay$45 copay
Tier 3: Preferred Brand Name$141 copay$141 copay$141 copay
Tier 4: Non-Preferred Brand Name$300 copay$300 copay$300 copay
Tier 5: Specialty Tier25% coinsurance25% coinsurance25% coinsurance

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

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 EmblemHealth Essential (HMO) for New York

/
LEFEVRE, LIONEL
3101 CLARENDON RD
BROOKLYN, NY 11226
BIRNBAUM, STUART
1818 NEWKIRK AVE
BROOKLYN, NY 11226
OSEI-TUTU, PRUDENCE
84 LINDEN BLVD
BROOKLYN, NY 11226
SULTANA, SHARMEEN
1414 NEWKIRK AVE
BROOKLYN, NY 11226
KUNDU, SUBHENDU
1401 NEWKIRK AVE
BROOKLYN, NY 11226
CONDE, MARIE
350 OCEAN AVE
BROOKLYN, NY 11226
LIVERPOOL, STEVEN
322 LINDEN BLVD
BROOKLYN, NY 11226
PEREZ, WALTER
2146 BEVERLEY RD
BROOKLYN, NY 11226
PETROV, MANANA
353 OCEAN AVE
BROOKLYN, NY 11226
SOTNIK, REGINA
2146 BEVERLY ROAD
BROOKLYN, NY 11226
LEWIN, JONATHAN
1414 NEWKIRK AVE
BROOKLYN, NY 11226
ALVAREZ, ELSIE
601 E 18TH ST
BROOKLYN, NY 11226
KEROLLE, HAROLD
1050 OCEAN AVE
BROOKLYN, NY 11226
PERVEZ, RAHILA
29 NEWKIRK PLZ
BROOKLYN, NY 11226
ANGLADE, ALBERT
1515 CHURCH AVE
BROOKLYN, NY 11226
SCHMIDT, MARIE
2324 BEVERLY ROAD
BROOKLYN, NY 11226
IGNACIO, ERLINDA
1095 FLATBUSH AVE
BROOKLYN, NY 11226
ANSAY, VIRGILIO
1095 FLATBUSH AVE
BROOKLYN, NY 11226
JEAN-FRANCOIS, T.
622 OCEAN AVE
BROOKLYN, NY 11226
HOROWITZ, STEVEN
1414 NEWKIRK AVE
BROOKLYN, NY 11226
VALME, GERALD
1010 OCEAN AVE
BROOKLYN, NY 11226
TELLUS, FRANCOIS
3101 CLARENDON RD
BROOKLYN, NY 11226
BOAH, AKUA
145 E 18TH ST
BROOKLYN, NY 11226
BRIGGS, HAYDN
136 LINDEN BLVD.
BROOKLYN, NY 11226
MAYLOR, DAPHNEY
871 OCEAN AVE
BROOKLYN, NY 11226
Details
LIONEL LEFEVRE, M.D.
Phone Number
(718) 462-6611
Office Locations
3101 CLARENDON RD
BROOKLYN, NY 11226
3101 CLARENDON RD BROOKLYN NY, 11226

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