PARTCRX

Plan Summary

Insurance Type
Medicare Advantage Plan (Part C w/ RX)
Insurance Provider
Kaiser Permanente
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 been rated 5 stars by CMS
  • was the 2nd best selling plan in Adams in 2014

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
$4,000 In-network
Other Health Plan Deductibles?
No
Health Plan Deductible
$0
Monthly Drug Plan Premium
$35.60
Monthly Health Plan Premium
$10.40

Benefits

Service
Cost
Ambulance
$285
Doctor's office visits
Primary Physician
$5-10 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
$225 for days 1 through 5
$0 for days 6 through 90
Outpatient hospital
$0-225 per visit
Renal dialysis
20% per visit
Inpatient hospital care
$225 for days 1 through 5
$0 for days 6 through 90
Skilled Nursing Facility (SNF)
$0 for days 1 through 20
$100 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$6 copay$6 copay$6 copay
Tier 2: Non-Preferred Generic$10 copay$10 copay$10 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 Tier33% coinsurance33% coinsurance33% coinsurance
90 Day SupplyPreferred Retail PharmaciesNon-Preferred Retail PharmaciesMail-Order Pharmacies
Tier 1: Preferred Generic$18 copay$18 copay$12 copay
Tier 2: Non-Preferred Generic$30 copay$30 copay$20 copay
Tier 3: Preferred Brand Name$141 copay$141 copay$94 copay
Tier 4: Non-Preferred Brand Name$300 copay$300 copay$200 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
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 Senior Advantage Silver (HMO) for Colorado

/
DURBIN, ROY
1930 S FEDERAL BLVD
DENVER, CO 80219
GARRETT, RAYMOND
1930 S FEDERAL BLVD
DENVER, CO 80219
WESTLEY, CHARLES
8383 W ALAMEDA AVE
LAKEWOOD, CO 80226
BUDDE, LUCY
8383 W ALAMEDA AVE
LAKEWOOD, CO 80226
ANDERSON, TRACY
8383 W ALAMEDA AVE
LAKEWOOD, CO 80226
LEE, LI-FEN
8383 W ALAMEDA AVE
LAKEWOOD, CO 80226
BARMORE, JASON
8383 W ALAMEDA AVE
LAKEWOOD, CO 80226
DAVIS, JOYCE
8383 W ALAMEDA AVE
LAKEWOOD, CO 80226
PHILIPSON, THOMAS
8383 W ALAMEDA AVE
LAKEWOOD, CO 80226
DOSHI, JAYNA
8383 W ALAMEDA AVE
LAKEWOOD, CO 80226
WALCHER, ANGELA
8383 W ALAMEDA AVE
LAKEWOOD, CO 80226
MARTINEZ, DAVID
8383 W ALAMEDA AVE
LAKEWOOD, CO 80226
FISHMAN, SUZANNE
8383 W ALAMEDA AVE
LAKEWOOD, CO 80226
COAKLEY, LEEANNE
8383 W ALAMEDA AVE
LAKEWOOD, CO 80226
SHULL, HEATHER
8383 W ALAMEDA AVE
LAKEWOOD, CO 80226
SCHLICHT, MALINDA
8383 W ALAMEDA AVE
LAKEWOOD, CO 80226
MAGUIRE, MARY
8383 W ALAMEDA AVE
LAKEWOOD, CO 80226
LACKEY, MARGARET
9808 W CEDAR AVE
LAKEWOOD, CO 80226
CLARK, LAURA
8383 W ALAMEDA AVE
LAKEWOOD, CO 80226
KERN, TANYA
8383 W ALAMEDA AVE
LAKEWOOD, CO 80226
SCHINDEL, MICHAEL
7444 W ALASKA DR
LAKEWOOD, CO 80226
OHTAKE, ATSUKO
8383 W ALAMEDA AVE
LAKEWOOD, CO 80226
FIXMAN, SUSAN
8383 W ALAMEDA AVE
LAKEWOOD, CO 80226
PEARSON, LESLIE
8383 W ALAMEDA AVE
LAKEWOOD, CO 80226
MUELLER, CLAIRE
8383 W ALAMEDA AVE
LAKEWOOD, CO 80226
Details
ROY DURBIN, M.D.
Phone Number
(303) 934-2202
Office Locations
1930 S FEDERAL BLVD
DENVER, CO 80219
1930 S FEDERAL BLVD DENVER CO, 80219

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