PARTCRX

Plan Summary

Insurance Type
Medicare Advantage Plan (Part C w/ RX)
Insurance Provider
Health Net
CMS Rating
Plan Type
HMO SNP
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
$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 Services
$40 copay
If you are admitted to the hospital, you do not have to pay for the
ambulance services.
Doctors Office Visits
Primary care physician visit: You pay nothing
Specialist visit: You pay nothing
Emergency Care
$75 copay
If you are immediately admitted to the hospital, 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.
$50,000 plan coverage limit for supplemental urgent/emergent
services outside the U.S. and its territories every year.
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.
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 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.
• $900 copay per stay
Outpatient group therapy visit: $25 copay
Outpatient individual therapy visit: $25 copay
Outpatient hospital
You pay nothing
Renal dialysis
20% per visit
Inpatient Hospital Care
Our plan covers an unlimited number of days for an inpatient hospital
stay.
You pay nothing
Diabetes Supplies and Services
Diabetes monitoring supplies: You pay nothing
Diabetes self-management training: You pay nothing
Therapeutic shoes or inserts: You pay nothing
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.
Prosthetic Devices (braces artificial limbsetc.)
Prosthetic devices: 10% of the cost
Related medical supplies: You pay nothing
Outpatient Substance Abuse
Group therapy visit: $25 copay
Individual therapy visit: $25 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: You pay nothing
Physical therapy and speech and language therapy visit: You pay
nothing
Hospice
You pay nothing for hospice care from a Medicare-certified hospice.
You may have to pay part of the costs for drugs and respite care.
Hospice is covered outside of our plan. Please contact us for more
details.
Transportation
You pay nothing
Up to 32 one-way trips to plan approved location every year
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): $60 copay
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): $60 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):
$0 copay
Preventive dental services:
•Cleaning (for up to 2 every year): $0 copay
•Dental x-ray(s) (for up to 1 every year): $0 copay
•Fluoride treatment (for up to 1 every year): $0 copay
•Oral exam: $0 copay
Additional comprehensive dental benefits are available
Vision Services
Exam to diagnose and treat diseases and conditions of the eye
(including yearly glaucoma screening): $0 copay
Routine eye exam (for up to 1 every year): $0 copay
Contact lenses (for up to 1 every two years): $0 copay
Eyeglasses (frames and lenses) (for up to 1 every two years): $0
copay
Eyeglass frames (for up to 1 every two years): $0 copay
Eyeglass lenses (for up to 1 every two years): $0 copay
Eyeglasses or contact lenses after cataract surgery: $0 copay
Our plan pays up to $250 every two years for eyewear.
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 three years): $0 copay
Hearing aid: $0 copay
Our plan pays up to $1,000 every three years for hearing aids.
Up to 2 supplemental hearing aids every three years. You are
responsible for the balance after the maximum allowance is applied.
Renal Dialysis
20% of the cost
Outpatient Surgery
Ambulatory surgical center: You pay nothing
Outpatient hospital: You pay nothing
Chiropractic Care
Manipulation of the spine to correct a subluxation (when 1 or more of
the bones of your spine move out of position): You pay nothing
Foot Care
Foot exams and treatment if you have diabetes-related nerve damage
and/or meet certain conditions: You pay nothing
Routine foot care (for up to 12 visit(s) every year): You pay nothing
Urgent Care
You pay nothing
If you are immediately admitted to the hospital, 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 for days 1 through 31
$25 copay per day for days 32 through 100
Durable Medical Equipment (wheelchairs oxygen etc.)
10% of the cost

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$15 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$45 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 Jade (HMO SNP) for California

/
CADRY, MEHRANGIZ
2707 S CENTRAL AVE
LOS ANGELES, CA 90011
GHAFUR, NAEEMAH
2707 S CENTRAL AVE
LOS ANGELES, CA 90011
HERRERA, GASTON
1061 E. VERNON AVE SUITE# F
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
CHAVEZ, EDGAR
1005 E WASHINGTON BLVD STE A
LOS ANGELES, CA 90021
COLLINS, CHANTELLE
2250 ALCAZAR ST.
LOS ANGELES, CA 90089
SPICER, DARCY
1441 EASTLAKE AVE
LOS ANGELES, CA 90089
BOYD, STUART
1441 EASTLAKE AVE
LOS ANGELES, CA 90089
GINSBERG, DAVID
1441 EASTLAKE AVE
LOS ANGELES, CA 90089
LIN, YVONNE
1441 EASTLAKE AVE # 7419
LOS ANGELES, CA 90089
CHAKRYAN, YERVAND
2020 ZONAL AVE STE 620
LOS ANGELES, CA 90089
AULT, GLENN
1441 EASTLAKE AVE
LOS ANGELES, CA 90089
PHAM, HUYEN
1441 EASTLAKE AVE
LOS ANGELES, CA 90089
VAINRIB, MICHAEL
1441 EASTLAKE AVE
LOS ANGELES, CA 90089
DORFF, TANYA
1441 EASTLAKE AVE
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
Details
MEHRANGIZ CADRY, MD
Phone Number
(310) 422-5001
Office Locations
2707 S CENTRAL AVE
LOS ANGELES, CA 90011
2707 S CENTRAL AVE LOS ANGELES CA, 90011

Similar Plans

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

Related Articles

Related Searches

{}