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
$4,100 In-network
Other Health Plan Deductibles?
Yes
Health Plan Deductible
$0
Monthly Drug Plan Premium
$0.00
Monthly Health Plan Premium
$0.00

Benefits

Service
Cost
Ambulance Services
$250 copay
Doctors Office Visits
Primary care physician visit: You pay nothing
Specialist visit: $30 copay
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.
  • $250 copay per day for days 1 through 4

  • You pay nothing per day for days 5 through 90

  • Outpatient group therapy visit: $30 copay
    Outpatient individual therapy visit: $30 copay
    Outpatient hospital
    $200 per visit
    Renal dialysis
    20% per visit
    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 an unlimited number of days for an inpatient hospital
    stay.
  • $250 copay per day for days 1 through 4

  • You pay nothing per day for days 5 through 90

  • You pay nothing per day for days 91 and beyond
  • Diabetes Supplies and Services
    Diabetes monitoring supplies: You pay nothing
    Diabetes self-management training: You pay nothing
    Therapeutic shoes or inserts: 20% of the cost
    Acupuncture
    This plan covers acupuncture benefits for an extra cost. See the
    "Optional Benefits" section of this booklet for these costs.
    Outpatient Substance Abuse
    Group therapy visit: $30 copay
    Individual therapy visit: $30 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: $20 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): $125-200
    copay, depending on the service
    Diagnostic tests and procedures: You pay nothing
    Lab services: You pay nothing
    Outpatient x-rays: $15 copay
    Therapeutic radiology services (such as radiation treatment for
    cancer): 20% of the cost
    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): $30
    copay after you pay your deductible
    Vision Services
    Exam to diagnose and treat diseases and conditions of the eye
    (including yearly glaucoma screening): $0-30 copay, depending on the
    service
    Eyeglasses or contact lenses after cataract surgery: You pay nothing.
    Hearing Services
    Exam to diagnose and treat hearing and balance issues: $15 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.
    Prosthetic Devices (braces artificial limbs etc.)
    Prosthetic devices: 20% of the cost
    Related medical supplies: 20% of the cost
    Renal Dialysis
    20% of the cost
    Outpatient Surgery
    Ambulatory surgical center: $150 copay
    Outpatient hospital: $200 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: $30 copay
    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
  • Durable Medical Equipment (wheelchairs oxygen etc.)
    20% 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$12 copay$17 copay$12 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$36 copay$51 copay$33 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 Ruby Select (HMO) for Arizona

    /
    MAGU, BHARAT
    2400 S AVENUE A
    YUMA, AZ 85364
    LWIN, TIN
    2400 S AVE A
    YUMA, AZ 85364
    PLANTE, MARK
    381 S MAIN ST
    YUMA, AZ 85364
    SMYTHE, ROBERT
    2775 S 8TH AVE
    YUMA, AZ 85364
    LAU, AUGUSTINE
    2375 S. RIDGEVIEW DRIVE
    YUMA, AZ 85364
    HERMENAU, SHAWN
    2851 S AVENUE B
    YUMA, AZ 85364
    COHEN, STANTON
    1743 W 24TH ST
    YUMA, AZ 85364
    GALANG, TIMOTHY
    1320 W 24TH ST
    YUMA, AZ 85364
    GROGAN, BRIAN
    2911 S 8TH AVE
    YUMA, AZ 85364
    GASCA-HOLTZ, MARIA
    2911 S 8TH AVE
    YUMA, AZ 85364
    MARTINEZ, ERICK
    2911 S 8TH AVE
    YUMA, AZ 85364
    SUCIU, THOMAS
    2911 S 8TH AVE
    YUMA, AZ 85364
    WESTER-EBBINGHAUS, WERNER
    2911 S 8TH AVE
    YUMA, AZ 85364
    NGUYEN, LOC
    1001 W 16TH ST
    YUMA, AZ 85364
    MILLER, SETH
    1030 W 24TH ST
    YUMA, AZ 85364
    AMON, JOHN
    2911 SOUTH 8TH AVENUE
    YUMA, AZ 85364
    RUNYAN, DONALD
    2400 S AVENUE A
    YUMA, AZ 85364
    DICKSON, MATTHEW
    2400 S AVENUE A
    YUMA, AZ 85364
    CARSON, JOHN
    2400 S AVENUE A
    YUMA, AZ 85364
    BAZZI, ALEIX
    2095 W. 24TH STREET
    YUMA, AZ 85364
    CURRY, JEREMY
    2270 S RIDGEVIEW DRIVE
    YUMA, AZ 85364
    SOLIMAN, MOHAMMAD
    1763 W 24TH ST
    YUMA, AZ 85364
    CARROLL, BRENDA
    1320 W 24TH ST
    YUMA, AZ 85364
    ANDERSON, JOHN
    2110 W. 24TH STREET, SUITE C
    YUMA, AZ 85364
    NACHIAPPAN, NACCHAL
    2400 S AVENUE A
    YUMA, AZ 85364
    Details
    BHARAT MAGU, MD
    Phone Number
    (928) 336-3213
    Office Locations
    2400 S AVENUE A
    YUMA, AZ 85364
    2400 S AVENUE A YUMA AZ, 85364

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