PARTCRX

Plan Summary

Insurance Type
Medicare Advantage Plan (Part C w/ RX)
Insurance Provider
Kaiser Permanente
CMS Rating
Plan Type
Cost
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 been rated 5 stars by CMS

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
$5,500 In-network
Other Health Plan Deductibles?
No
Health Plan Deductible
$0
Monthly Drug Plan Premium
$19.10
Monthly Health Plan Premium
$5.90

Benefits

Service
Cost
Ambulance
$225
Doctor's office visits
Primary Physician
$20 per visit
Specialist
$40 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
$675 per stay
Outpatient hospital
$225 per visit
Renal dialysis
You pay nothing
Inpatient hospital care
$675 per stay
Skilled Nursing Facility (SNF)
$0 for days 1 through 20
$150 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$7 copay$10 copay$7 copay
Tier 2: Non-Preferred Generic$15 copay$20 copay$15 copay
Tier 3: Preferred Brand Name$42 copay$47 copay$42 copay
Tier 4: Non-Preferred Brand Name$95 copay$100 copay$95 copay
Tier 5: Specialty Tier33% coinsurance33% coinsurance33% coinsurance
90 Day SupplyPreferred Retail PharmaciesNon-Preferred Retail PharmaciesMail-Order Pharmacies
Tier 1: Preferred Generic$21 copay$30 copay$0 copay
Tier 2: Non-Preferred Generic$45 copay$60 copay$30 copay
Tier 3: Preferred Brand Name$126 copay$141 copay$84 copay
Tier 4: Non-Preferred Brand Name$285 copay$300 copay$190 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
Not Rated
Care for older adults – medication review
Not Rated
Care for older adults – functional status assessment
Not Rated
Care for older adults – Pain screening
Not Rated
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
Not Rated

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
Not Rated

Drug Plan Customer Service

Call center – foreign language interpreter and TTY/TDD availability - Drugs
Not Rated
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 Kaiser Permanente Medicare Plus Std w/Part D (AB) (Cost) for District Of Columbia

/
AKHIGBE, EHIGIATOR
5413 ILLINOIS AVE NW
WASHINGTON, DC 20011
MCGINTY, DANA
1208 CRITTENDEN ST NW
WASHINGTON, DC 20011
PRIDDY, EUGENIA
1221 TAYLOR ST NW
WASHINGTON, DC 20011
OLIVER, JAMES
5422 1ST PL NW
WASHINGTON, DC 20011
MYERS, LINDA
1407 RITTENHOUSE ST NW
WASHINGTON, DC 20011
DOWNING, DAVID
106 IRVING ST NW
WASHINGTON, DC 20010
MIMS, OSCAR
106 IRVING ST NW
WASHINGTON, DC 20010
KODGI, MALADY
110 IRVING ST NW
WASHINGTON, DC 20010
KAMBOURIS, NICHOLAS
110 IRVING ST NW
WASHINGTON, DC 20010
CAO, CATHY
110 IRVING ST NW
WASHINGTON, DC 20010
GHASEMIAN, SEYED
110 IRVING ST NW
WASHINGTON, DC 20010
LIGHT, JIMMY
110 IRVING ST NW
WASHINGTON, DC 20010
RUBINSTEIN, ADAM
110 IRVING ST. NW
WASHINGTON, DC 20010
GOMEZ-LOBO, VERONICA
110 IRVING ST NW
WASHINGTON, DC 20010
MELANCON, MARY
106 IRVING ST NW
WASHINGTON, DC 20010
MUANGMAN, SCOTT
106 IRVING ST NW
WASHINGTON, DC 20010
BLACK, SUSAN
106 IRVING ST NW
WASHINGTON, DC 20010
COLLINS, MAURA
111 MICHIGAN AVE NW
WASHINGTON, DC 20010
TIFFT, CYNTHIA
111 MICHIGAN AVE NW
WASHINGTON, DC 20010
ANTWI-DONKOR, ERIC
106 IRVING ST NW
WASHINGTON, DC 20010
GUPTA, ROOPALI
110 IRVING ST NW STE NW # 2A-70
WASHINGTON, DC 20010
BIVINS, ANTHONY
106 IRVING ST NW
WASHINGTON, DC 20010
OCUIN, JAY
106 IRVING ST NW
WASHINGTON, DC 20010
RUIZ, MARIA
110 IRVING ST NW
WASHINGTON, DC 20010
OBOLER, ALLEN
110 IRVING ST NW
WASHINGTON, DC 20010
Details
EHIGIATOR AKHIGBE, M.D.
Phone Number
(202) 723-4392
Office Locations
5413 ILLINOIS AVE NW
WASHINGTON, DC 20011
5413 ILLINOIS AVE NW WASHINGTON DC, 20011

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