2019 Allwell Medicare Essentials (HMO) H5590-5-0 in AZ from allwell | HealthPocket

Allwell Medicare Essentials (HMO)

$0/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 IDH5590-5-0
Plan Year2019
CMS Rating
Plan TypeHMO
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 no additional premium costs outside of your Medicare Part B premium
  • has a copay of $0 for Tier 1 preferred generic drugs (30 day supply, preferred retail pharmacies)

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)$3,400 In-network
Optional Supplemental BenefitsNo

Benefits

SERVICECOST
Inpatient hospital coverage$190 per day for days 1 through 8
$0 per day for days 9 through 90
$0 per day for days 91 and beyond
Outpatient hospital coverage$200 per visit
Doctor visitsPrimary:$0 copay
Specialist:$15 per visit
Preventive care$0 copay
Emergency care/Urgent careEmergency:$120 per visit (always covered)
Urgent care:$20 per visit (always covered)
Diagnostic procedures/lab services/imagingDiagnostic tests and procedures:$0 copay
Lab services:$10-25
Diagnostic radiology services (e.g., MRI):$125-200
Outpatient x-rays:$10-75
Mental health servicesInpatient hospital - psychiatric:$190 per day for days 1 through 8
$0 per day for days 9 through 90
Outpatient group therapy visit with a psychiatrist:$25
Outpatient individual therapy visit with a psychiatrist:$25
Outpatient group therapy visit:$25
Outpatient individual therapy visit:$25
Skilled Nursing Facility$0 per day for days 1 through 20
$170 per day for days 21 through 100
Rehabilitation servicesOccupational therapy visit:$35
Physical therapy and speech and language therapy visit:$35
Ground ambulance$275
TransportationNot covered
Foot care (podiatry services)Foot exams and treatment:$25
Routine foot care:Not covered
Medical equipment/suppliesDurable medical equipment (e.g., wheelchairs, oxygen):20% per item
Prosthetics (e.g., braces, artificial limbs):20% per item
Diabetes supplies:$0 copay
Wellness programs (e.g., fitness, nursing hotline)Covered
Medicare Part B drugsChemotherapy:20%
Other Part B drugs:20%

Benefits Services

Hearing
Hearing exam$15
Fitting/evaluation$0 copay. There may be limits on how much the plan will provide.
Hearing aids$0-995There 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 examNot covered
OtherNot covered
Contact lensesNot covered
Eyeglasses (frames and lenses)Not covered
Eyeglass framesNot covered
Eyeglass lensesNot covered
UpgradesNot covered

Coverage Area for Allwell Medicare Essentials (HMO)

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 Generic$0 copay$5 copayNot offered
Tier 2: Non-Preferred Generic$15 copay$20 copayNot offered
Tier 3: Preferred Brand Name$37 copay$47 copayNot offered
Tier 4: Non-Preferred Brand Name$90 copay$100 copayNot offered
Tier 5: Specialty Tier33% coinsurance33% coinsuranceNot offered

60 Day SupplyPreferred Retail PharmaciesNon-Preferred Retail PharmaciesMail-Order Pharmacies
Tier 1: Preferred Generic$0 copay$10 copayNot offered
Tier 2: Non-Preferred Generic$30 copay$40 copayNot offered
Tier 3: Preferred Brand Name$74 copay$94 copayNot offered
Tier 4: Non-Preferred Brand Name$180 copay$200 copayNot offered
Tier 5: Specialty Tier
90 Day SupplyPreferred Retail PharmaciesNon-Preferred Retail PharmaciesMail-Order Pharmacies
Tier 1: Preferred Generic$0 copay$15 copayNot offered
Tier 2: Non-Preferred Generic$45 copay$60 copayNot offered
Tier 3: Preferred Brand Name$111 copay$141 copayNot offered
Tier 4: Non-Preferred Brand Name$270 copay$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 Medicare Essentials (HMO) 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.