2019 Allwell Dual Medicare (HMO SNP) H5590-6-1 in AZ from allwell | HealthPocket

Allwell Dual Medicare (HMO SNP)

$32/mo

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Zip Code85364
Applicant1/21/1984 Male
Coverage Start1/23/2019
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Benefits & Coverage

Insurance TypeMedicare Advantage Plan (Part C w/ RX)
Insurance Providerallwell
Plan IDH5590-6-1
Plan Year2019
CMS Rating
Plan TypeHMO SNP
Annual Deductible$200.00

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$32.60
Health Plan Deductible$0 or $185 per year for in-network services.
Other health plan deductibles?No
Maximum out-of-pocket enrollee responsibility (does not include prescription drugs)$3,400 In-network
Optional Supplemental BenefitsNo

Benefits

SERVICECOST
Inpatient hospital coverageIn 2019 the amounts for each benefit period are $0 or:
$1,364 deductible for days 1 through 60
$341 copay per day for days 61 through 90
Outpatient hospital coverage0% or 20% per visit
Doctor visitsPrimary:0% or 20% per visit
Specialist:0% or 20% per visit
Preventive care$0 copay
Emergency care/Urgent careEmergency:0% or 20% per visit (always covered)
Urgent care:0% or 20% per visit (always covered)
Diagnostic procedures/lab services/imagingDiagnostic tests and procedures:0% or 20%
Lab services:$0 copay
Diagnostic radiology services (e.g., MRI):0% or 20%
Outpatient x-rays:0% or 20%
Mental health servicesInpatient hospital - psychiatric:In 2019 the amounts for each benefit period are $0 or:
$1,364 deductible for days 1 through 60
$341 copay per day for days 61 through 90
Outpatient group therapy visit with a psychiatrist:0% or 20%
Outpatient individual therapy visit with a psychiatrist:0% or 20%
Outpatient group therapy visit:0% or 20%
Outpatient individual therapy visit:0% or 20%
Skilled Nursing FacilityIn 2019 the amounts for each benefit period are $0 or:
$0 copay for days 1 through 20
$170.50 copay per day for days 21 through 100
Rehabilitation servicesOccupational therapy visit:0% or 20%
Physical therapy and speech and language therapy visit:0% or 20%
Ground ambulance0% or 20%
Transportation$0 copay. There may be limits on how much the plan will provide.
Foot care (podiatry services)Foot exams and treatment:0% or 20%
Routine foot care:Not covered
Medical equipment/suppliesDurable medical equipment (e.g., wheelchairs, oxygen):0% or 20% per item
Prosthetics (e.g., braces, artificial limbs):0% or 20% per item
Diabetes supplies:0% or 20% per item
Wellness programs (e.g., fitness, nursing hotline)Covered
Medicare Part B drugsChemotherapy:0% or 20%
Other Part B drugs:0% or 20%

Benefits Services

Hearing
Hearing exam0% or 20%
Fitting/evaluation$0 copay. There may be limits on how much the plan will provide.
Hearing aids$0-1,580There may be limits on how much the plan will provide.
Preventive Dental
Oral exam$0 copay. There may be limits on how much the plan will provide.
Cleaning$0 copay. There may be limits on how much the plan will provide.
Fluoride treatmentNot covered
Dental x-ray(s)$0 copay. There may be limits on how much the plan will provide.
Comprehensive Dental
Non-routine servicesNot covered
Diagnostic services$0 copay. There may be limits on how much the plan will provide.
Restorative services$0 copay. There may be limits on how much the plan will provide.
Endodontics$0 copay. There may be limits on how much the plan will provide.
Periodontics$0 copay. There may be limits on how much the plan will provide.
Extractions$0 copay. There may be limits on how much the plan will provide.
Prosthodontics, other oral/maxillofacial surgery, other services$0 copay. There may be limits on how much the plan will provide.
Vision
Routine eye exam$0 copay. There may be limits on how much the plan will provide.
OtherNot covered
Contact lenses$0 copay. There may be limits on how much the plan will provide.
Eyeglasses (frames and lenses)$0 copay. There may be limits on how much the plan will provide.
Eyeglass framesNot covered
Eyeglass lensesNot covered
UpgradesNot covered

Coverage Area for Allwell Dual Medicare (HMO SNP)

StateArizona
CountyYuma

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 GenericNot offered$20 copayNot offered
Tier 3: Preferred Brand NameNot offered$47 copayNot offered
Tier 4: Non-Preferred Brand NameNot offered$100 copayNot offered
Tier 5: Specialty TierNot offered29% coinsuranceNot offered

60 Day SupplyPreferred Retail PharmaciesNon-Preferred Retail PharmaciesMail-Order Pharmacies
Tier 1: Preferred GenericNot offered$0 copayNot offered
Tier 2: Non-Preferred GenericNot offered$40 copayNot offered
Tier 3: Preferred Brand NameNot offered$94 copayNot offered
Tier 4: Non-Preferred Brand NameNot offered$200 copayNot offered
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 GenericNot offered$60 copayNot offered
Tier 3: Preferred Brand NameNot offered$141 copayNot offered
Tier 4: Non-Preferred Brand NameNot offered$300 copayNot offered
Tier 5: Specialty Tier

Staying healthy - screenings, tests and vaccines

Breast cancer screening
Colorectal cancer screening
Annual flu vaccineNot Rated
Improving or maintaining physical health
Improving or maintaining mental health
Monitoring physical ability
Adult BMI assessment

Managing Chronic Conditions

Special needs plan care managementNot Rated
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 monitoring
Diabetes care – blood sugar controlled
Controlling blood pressure
Rheumatoid arthritis managementNot Rated
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 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 improvement

Health Plan Customer Service

Plan makes timely decision about appealsNot Rated
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 planNot Rated
Beneficiary access and performance problems
Drug plan quality improvementNot Rated

Member Experience with Drug Plan

Rating of drug plan
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 Not Rated

Physicians that accept Allwell Dual Medicare (HMO SNP) for Arizona

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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.

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.