Plan Details
Costs and Other Important Information
Plan Year:
2018
Optional Supplemental Benefits
No
Maximum out-of-pocket enrollee responsibility (does not include prescription drugs)
$3,900 In-network
Other health plan deductibles?
No
Health Plan Deductible
$0
Monthly Drug Plan Premium
$27.60
Monthly Health Plan Premium
$19.40
Benefits
Service
Cost
Inpatient hospital coverage
$195 for days 1 through 5
$0 for days 6 through 90
$0 for days 91 and beyond
$0 for days 6 through 90
$0 for days 91 and beyond
Outpatient hospital coverage
$195 per visit
Doctor visits
Primary:
$0 copay
Specialist:
$20 per visit
$0 copay
Specialist:
$20 per visit
Preventive care
$0 copay
Emergency care/Urgent care
Emergency:
$80 per visit (always covered)
Urgent care:
$20-40 per visit (always covered)
$80 per visit (always covered)
Urgent care:
$20-40 per visit (always covered)
Diagnostic procedures/lab services/imaging
Diagnostic tests and procedures:
20%
Lab services:
$0
Diagnostic radiology services (e.g., MRI):
$75
Outpatient x-rays:
$14
20%
Lab services:
$0
Diagnostic radiology services (e.g., MRI):
$75
Outpatient x-rays:
$14
Mental health services
$195 for days 1 through 5
$0 for days 6 through 90
Outpatient group therapy visit with a psychiatrist:
$30
Outpatient individual therapy visit with a psychiatrist:
$40
Outpatient group therapy visit:
$30
Outpatient individual therapy visit:
$40
$0 for days 6 through 90
Outpatient group therapy visit with a psychiatrist:
$30
Outpatient individual therapy visit with a psychiatrist:
$40
Outpatient group therapy visit:
$30
Outpatient individual therapy visit:
$40
Skilled Nursing Facility
$0 for days 1 through 20
$160 for days 21 through 45
$0 for days 46 through 100
$160 for days 21 through 45
$0 for days 46 through 100
Rehabilitation services
Occupational therapy visit:
$20
Physical therapy and speech and language therapy visit:
$20
$20
Physical therapy and speech and language therapy visit:
$20
Ambulance
$250
Transportation
Not covered
Foot care (podiatry services)
Foot exams and treatment:
$20
Routine foot care:
$20
$20
Routine foot care:
$20
Medical equipment/supplies
Durable medical equipment (e.g., wheelchairs, oxygen):
20% per item
Prosthetics (e.g., braces, artificial limbs):
20% per item
Diabetes supplies:
$0 per item
20% per item
Prosthetics (e.g., braces, artificial limbs):
20% per item
Diabetes supplies:
$0 per item
Wellness programs (e.g., fitness, nursing hotline)
Covered
Medicare Part B drugs
Chemotherapy:
20%
Other Part B drugs:
20%
20%
Other Part B drugs:
20%
Coverage Area for AARP MedicareComplete 2 (HMO)
| State | Alabama |
|---|---|
| County | Jefferson |
Cost Sharing Information
All cost-sharing assumes in-network healthcare providers.
Prescription Drug Copay/Coninsurance Details - Initial Coverage Limit
| 30 Day Supply | Preferred Retail Pharmacies | Non-Preferred Retail Pharmacies | Mail-Order Pharmacies |
|---|---|---|---|
| Tier 1: Preferred Generic | Not offereds | $3 copay | Not offered |
| Tier 2: Non-Preferred Generic | Not offered | $10 copay | Not offered |
| Tier 3: Preferred Brand Name | Not offered | $45 copay | Not offered |
| Tier 4: Non-Preferred Brand Name | Not offered | $95 copay | Not offered |
| Tier 5: Specialty Tier | Not offered | 33% coinsurance | Not offered |
| 90 Day Supply | Preferred Retail Pharmacies | Non-Preferred Retail Pharmacies | Mail-Order Pharmacies |
|---|---|---|---|
| Tier 1: Preferred Generic | Not offered | $9 copay | $0 copay |
| Tier 2: Non-Preferred Generic | Not offered | $30 copay | $0 copay |
| Tier 3: Preferred Brand Name | Not offered | $135 copay | $125 copay |
| Tier 4: Non-Preferred Brand Name | Not offered | $285 copay | $275 copay |
| Tier 5: Specialty Tier | Not offered | 33% coinsurance | 33% coinsurance |
Physician Finder
Physicians that accept AARP MedicareComplete 2 (HMO) for Alabama
/
Details
JAMES CUSTIS, MD
Phone Number
(205) 833-6888
Office Locations9772 PARKWAY E
BIRMINGHAM, AL 35215
