2019 Tribute (HMO-POS SNP) H1587-1-0 in AR from Superior Select Health Plans | HealthPocket

Tribute (HMO-POS SNP)

$23/mo

Apply For This Plan

Zip Code72209
Applicant8/24/1984 Male
Coverage Start8/25/2019
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Benefits & Coverage

Insurance TypeMedicare Advantage Plan (Part C w/ RX)
Insurance ProviderSuperior Select Health Plans
Plan IDH1587-1-0
Plan Year2019
CMS RatingNot Rated
Plan TypeHMO-POS SNP
Annual Deductible$415.00

What To Know About This Plan
  • This plan has health and drug coverage

Why We Like This Plan
  • has both Health and Drug Coverage

Costs and Other Important Information

Plan Year2019
Monthly Health Plan Premium$0.00
Monthly Drug Plan Premium$0.00
Health Plan Deductible$0
Other health plan deductibles?No
Maximum out-of-pocket enrollee responsibility (does not include prescription drugs)$6,700 In-network
Optional Supplemental BenefitsNo

Benefits

SERVICECOST
Inpatient hospital coverageIn-Network:$0 copay
Out-of-Network:Not Applicable
Outpatient hospital coverageIn-Network:$0 copay
Doctor visitsPrimary:
In-Network:$0 copay
Specialist:
In-Network:$0 copay
Preventive careIn-Network:$0 copay
Emergency care/Urgent careEmergency:$0 copay
Urgent care:$0 copay
Diagnostic procedures/lab services/imagingDiagnostic tests and procedures:
In-Network:$0 copay
Lab services:
In-Network:$0 copay
Diagnostic radiology services (e.g., MRI):
In-Network:$0 copay
Outpatient x-rays:
In-Network:$0 copay
Mental health servicesInpatient hospital - psychiatric:
In-Network:$0 copay
Out-of-Network:Not Applicable
Outpatient group therapy visit with a psychiatrist:
In-Network:$0 copay
Outpatient individual therapy visit with a psychiatrist:
In-Network:$0 copay
Outpatient group therapy visit:
In-Network:$0 copay
Outpatient individual therapy visit:
In-Network:$0 copay
Skilled Nursing FacilityIn-Network:$0 copay
Out-of-Network:Not Applicable
Rehabilitation servicesOccupational therapy visit:
In-Network:$0 copay
Physical therapy and speech and language therapy visit:
In-Network:$0 copay
Ground ambulanceIn-Network:$0 copay
TransportationNot covered
Foot care (podiatry services)Foot exams and treatment:
In-Network:$0 copay
Routine foot care:Not covered
Medical equipment/suppliesDurable medical equipment (e.g., wheelchairs, oxygen):
In-Network:$0 copay
Prosthetics (e.g., braces, artificial limbs):
In-Network:$0 copay
Diabetes supplies:
In-Network:$0 copay
Wellness programs (e.g., fitness, nursing hotline)Covered
Medicare Part B drugsChemotherapy:
In-Network:$0 copay
Other Part B drugs:
In-Network:$0 copay

Benefits Services

Hearing
Hearing examIn-Network: $0 copay
Fitting/evaluationIn-Network: $0 copay
Out-of-Network: $0 copay
There may be limits on how much the plan will provide.
Hearing aidsIn-Network: $0 copay
Out-of-Network: $0 copay
There may be limits on how much the plan will provide.
Preventive Dental
Oral examNot covered
CleaningNot covered
Fluoride treatmentNot covered
Dental x-ray(s)Not covered
Comprehensive Dental
Non-routine servicesNot covered
Diagnostic servicesNot covered
Restorative servicesNot covered
EndodonticsNot covered
PeriodonticsNot covered
ExtractionsNot covered
Prosthodontics, other oral/maxillofacial surgery, other servicesNot covered
Vision
Routine eye examIn-Network: $0 copay
Out-of-Network: $0 copay
There may be limits on how much the plan will provide.
OtherNot covered
Contact lensesNot covered
Eyeglasses (frames and lenses)In-Network: $0 copay
Out-of-Network: $0 copay
There may be limits on how much the plan will provide.
Eyeglass framesIn-Network: $0 copay
Out-of-Network: $0 copay
There may be limits on how much the plan will provide.
Eyeglass lensesIn-Network: $0 copay
Out-of-Network: $0 copay
There may be limits on how much the plan will provide.
UpgradesNot covered

Coverage Area for Tribute (HMO-POS SNP)

StateArkansas
CountyPulaski

All cost-sharing assumes in-network healthcare providers.
Prescription Drug Copay/Coninsurance Details - Initial Coverage Limit


30 Day SupplyPreferred Retail PharmaciesNon-Preferred Retail PharmaciesMail-Order Pharmacies
Tier 1: Preferred GenericNot offereds$0 copayNot offered
Tier 2: Non-Preferred Generic
Tier 3: Preferred Brand Name
Tier 4: Non-Preferred Brand Name
Tier 5: Specialty Tier

60 Day SupplyPreferred Retail PharmaciesNon-Preferred Retail PharmaciesMail-Order Pharmacies
Tier 1: Preferred GenericNot offered$0 copayNot offered
Tier 2: Non-Preferred Generic
Tier 3: Preferred Brand Name
Tier 4: Non-Preferred Brand Name
Tier 5: Specialty Tier
90 Day SupplyPreferred Retail PharmaciesNon-Preferred Retail PharmaciesMail-Order Pharmacies
Tier 1: Preferred GenericNot offered$0 copayNot offered
Tier 2: Non-Preferred Generic
Tier 3: Preferred Brand Name
Tier 4: Non-Preferred Brand Name
Tier 5: Specialty Tier

Staying healthy - screenings, tests and vaccines

Breast cancer screeningNot Rated
Colorectal cancer screeningNot Rated
Annual flu vaccineNot Rated
Improving or maintaining physical healthNot Rated
Improving or maintaining mental healthNot Rated
Monitoring physical abilityNot Rated
Adult BMI assessmentNot Rated

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 fractureNot Rated
Diabetes care – eye exam
Diabetes care – kidney disease monitoringNot Rated
Diabetes care – blood sugar controlledNot Rated
Controlling blood pressureNot Rated
Rheumatoid arthritis managementNot Rated
Reducing the risk of fallingNot Rated
Plan all-cause readmissionsNot Rated

Member Experience with Health Plan

Getting needed careNot Rated
Getting appointments and care quickly
Customer serviceNot Rated
Overall rating of health care qualityNot Rated
Overall rating of planNot Rated
Care CoordinationNot Rated

Member Complaints, and Changes in Health Plan's Performance

Complaints about the health planNot Rated
Members choosing to leave the health planNot Rated
Beneficiary access and performance problemsNot Rated
Health plan quality improvementNot Rated

Health Plan Customer Service

Plan makes timely decision about appeals
Reviewing appeals decisionsNot Rated
Call center – foreign language interpreter and TTY/TDD availability - MedicalNot Rated

Drug Plan Customer Service

Call center – foreign language interpreter and TTY/TDD availability - DrugsNot Rated
Appeals auto-forward
Appeals upheld

Member Complaints, and Changes in Drug Plan's Performance

Complaints about the drug planNot Rated
Members choosing to leave the drug planNot Rated
Beneficiary access and performance problemsNot Rated
Drug plan quality improvement

Member Experience with Drug Plan

Rating of drug planNot Rated
Getting needed prescription drugsNot Rated

Drug Pricing and Patient Safety

MPF Price AccuracyNot Rated
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
Statin Use in Persons with Diabetes

Physicians that accept Tribute (HMO-POS SNP) for Arkansas

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Cigna-HealthSpring Preferred AR (HMO)
COST:from $0CMS Rating:
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WellCare Premier (PPO)
COST:from $0CMS Rating:Not Rated
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Advantra Freedom (PPO)
COST:from $0CMS Rating:
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AARP MedicareComplete Plan 1 (HMO)
COST:from $0CMS Rating:Not Rated
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HumanaChoice R1532-001 (Regional PPO)
COST:from $0CMS Rating:
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HealthPocket is a free information source designed to help consumers find medical coverage. Whether you are looking for Medicare, Medicaid or an individual health insurance plan, we will help you find the right healthcare option and save on your out of pocket healthcare costs. We receive our data from government, non-profit and private sources, and you should confirm key provisions of your coverage with your selected health plan. If you select a plan presented on our site, you will be directed (via a click or a call) to one of our partners who can help you with your application. Our website is not a health insurance agency and not affiliated with and does not represent or endorse any health plan. HealthPocket, Inc. is a wholly owned subsidiary of Health Plan Intermediaries Holdings LLC (NASDAQ: HIIQ)

Medicare Plans Found

 

HealthPocket is a free information source designed to help consumers find medical coverage. Whether you are looking for Medicare, Medicaid or an individual health insurance plan, we will help you find the right healthcare option and save on your out of pocket healthcare costs. We receive our data from government, non-profit and private sources, and you should confirm key provisions of your coverage with your selected health plan. If you select a plan presented on our site, you will be directed (via a click or a call) to one of our partners who can help you with your application. Our website is not a health insurance agency and not affiliated with and does not represent or endorse any health plan. HealthPocket, Inc. is a wholly owned subsidiary of Health Plan Intermediaries Holdings LLC (NASDAQ: HIIQ)