PARTCRX

Plan Summary

Insurance Type
Medicare Advantage Plan (Part C w/ RX)
Insurance Provider
Health Net
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?
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
$0.00
Monthly Health Plan Premium
$0.00

Benefits

Service
Cost
Ambulance
$250
Doctor's office visits
Primary Physician
You pay nothing
Specialist
You pay nothing
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
$900 per stay
Outpatient hospital
You pay nothing
Renal dialysis
20% per visit
Inpatient hospital care
You pay nothing
Skilled Nursing Facility (SNF)
$0 for days 1 through 20
$75 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$5 copay$0 copay
Tier 2: Non-Preferred Generic$10 copay$20 copay$10 copay
Tier 3: Preferred Brand Name$37 copay$47 copay$37 copay
Tier 4: Non-Preferred Brand Name$90 copay$100 copay$90 copay
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$30 copay$60 copay$20 copay
Tier 3: Preferred Brand Name$111 copay$141 copay$101 copay
Tier 4: Non-Preferred Brand Name$270 copay$300 copay$260 copay
Tier 5: Specialty Tier33% coinsurance33% coinsurance33% 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 Health Net Gold Select (HMO) for California

/
GHAFUR, NAEEMAH
2707 S CENTRAL AVE
LOS ANGELES, CA 90011
BAHARI-NEJAD, PEJMAN
4425 S CENTRAL AVE
LOS ANGELES, CA 90011
NOYA, DAVID
4425 S CENTRAL AVE
LOS ANGELES, CA 90011
BROWN, BASSETT
2707 S CENTRAL AVE
LOS ANGELES, CA 90011
LAWRENCE, PATRICK
1061 E VERNON AVE
LOS ANGELES, CA 90011
MULL, JOHN
4425 SOUTH CENTRAL AVE
LOS ANGELES, CA 90011
KASHANI, HOUMAN
747 WAREHOUSE ST
LOS ANGELES, CA 90021
BLEAKLEY, DENNIS
515 E. 5TH STREET
LOS ANGELES, CA 90021
GREGERSON, PAUL
515 E. 5TH ST
LOS ANGELES, CA 90021
LARA, AGUSTIN
1005 E WASHINGTON BLVD
LOS ANGELES, CA 90021
LIN, YVONNE
1441 EASTLAKE AVE # 7419
LOS ANGELES, CA 90089
CHAKRYAN, YERVAND
2020 ZONAL AVE STE 620
LOS ANGELES, CA 90089
PIATEK, CAROLINE
1441 EASTLAKE AVE
LOS ANGELES, CA 90089
RIOS, EUNICE
IRD 115; 1200 N STATE STREET
LOS ANGELES, CA 90089
ARIAS, RAQUEL
1975 ZONAL AVE # KAM100-F
LOS ANGELES, CA 90089
UKIMURA, OSAMU
1441 EASTLAKE AVE
LOS ANGELES, CA 90089
BANSAL, SUMATI
2020 ZONAL AVE
LOS ANGELES, CA 90089
PRESS, MICHAEL
1441 EASTLAKE AVE
LOS ANGELES, CA 90089
LAI, ROSE
1441 EASTLAKE AVE
LOS ANGELES, CA 90089
LAI, KEANE
1333 SAN PABLO STREET
LOS ANGELES, CA 90089
HAWES, DEBRA
2011 ZONAL AVE
LOS ANGELES, CA 90089
DANIELS, JOHN
1441 EASTLAKE AVE
LOS ANGELES, CA 90089
WONG, MICHAEL
1441 EASTLAKE AVE
LOS ANGELES, CA 90089
NICHOLS, PETER
1441 EASTLAKE AVE
LOS ANGELES, CA 90089
SIDDIQI, IMRAN
2011 ZONAL AVE
LOS ANGELES, CA 90089
Details
NAEEMAH GHAFUR, M.D.
Phone Number
(323) 234-5000
Office Locations
2707 S CENTRAL AVE
LOS ANGELES, CA 90011
2707 S CENTRAL AVE LOS ANGELES CA, 90011

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