2019 Aspire Health Plus (HMO-POS) H8764-2-0 in CA from Aspire Health Plan | HealthPocket

Aspire Health Plus (HMO-POS)

$249/mo

Apply For This Plan

Zip Code90011
Applicant3/26/1984 Male
Coverage Start3/27/2019
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Benefits & Coverage

Insurance TypeMedicare Advantage Plan (Part C w/ RX)
Insurance ProviderAspire Health Plan
Plan IDH8764-2-0
Plan Year2019
CMS Rating
Plan TypeHMO-POS
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

Costs and Other Important Information

Plan Year2019
Monthly Health Plan Premium$166.00
Monthly Drug Plan Premium$83.00
Health Plan Deductible$0
Other health plan deductibles?No
Maximum out-of-pocket enrollee responsibility (does not include prescription drugs)$0 In and Out-of-network
$0 In-network
Optional Supplemental BenefitsYes

Benefits

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

Benefits Services

Hearing
Hearing examIn-Network: $0 copay
Out-of-Network: $0 copay
Fitting/evaluationNot covered
Hearing aids - inner earNot covered
Hearing aids - outer earNot covered
Hearing aids - over the earNot covered
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 Aspire Health Plus (HMO-POS)

StateCalifornia
CountyLos Angeles

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$10 copayNot offered
Tier 3: Preferred Brand NameNot offered$42 copayNot offered
Tier 4: Non-Preferred Brand NameNot offered$90 copayNot offered
Tier 5: Specialty TierNot offered33% coinsuranceNot offered

90 Day SupplyPreferred Retail PharmaciesNon-Preferred Retail PharmaciesMail-Order Pharmacies
Tier 1: Preferred GenericNot offered$0 copayNot offered
Tier 2: Non-Preferred GenericNot offered$30 copayNot offered
Tier 3: Preferred Brand NameNot offered$126 copayNot offered
Tier 4: Non-Preferred Brand NameNot offered$270 copayNot offered
Tier 5: Specialty TierNot offered33% coinsuranceNot offered

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 managementNot Rated
Care for older adults – medication reviewNot Rated
Care for older adults – functional status assessmentNot Rated
Care for older adults – Pain screeningNot Rated
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 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

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 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

Physicians that accept Aspire Health Plus (HMO-POS) for California

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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.