Care1st TotalDual (HMO SNP)

Medicare Advantage Plan for California

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PARTCRX

Plan Summary

Insurance TypeMedicare Advantage Plan (Part C w/ RX)
Insurance ProviderCare1st Health Plan
Plan IDH5928-1-0
CMS Rating1
Plan TypeHMO SNP
Annual Deductible$405.00

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

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)
$6,700 In-network
Other health plan deductibles?
No
Health Plan Deductible
$0
Monthly Drug Plan Premium
$0.00
Monthly Health Plan Premium
$0.00

Benefits

Service
Cost
Inpatient hospital coverage
$0 copay
Outpatient hospital coverage
$0 copay
Doctor visits
Primary:$0 copay
Specialist:$0 copay
Preventive care
$0 copay
Emergency care/Urgent care
Emergency:$0 copay
Urgent care:$0 copay
Diagnostic procedures/lab services/imaging
Diagnostic tests and procedures:$0 copay
Lab services:$0 copay
Diagnostic radiology services (e.g., MRI):$0 copay
Outpatient x-rays:$0 copay
Mental health services
$0 copay
Outpatient group therapy visit with a psychiatrist:$0 copay
Outpatient individual therapy visit with a psychiatrist:$0 copay
Outpatient group therapy visit:$0 copay
Outpatient individual therapy visit:$0 copay
Skilled Nursing Facility
$0 copay
Rehabilitation services
Occupational therapy visit:$0 copay
Physical therapy and speech and language therapy visit:$0 copay
Ambulance
$0 copay
Transportation
$0 copay
Foot care (podiatry services)
Foot exams and treatment:$0 copay
Routine foot care:$0 copay
Medical equipment/supplies
Durable medical equipment (e.g., wheelchairs, oxygen):$0 copay
Prosthetics (e.g., braces, artificial limbs):$0 copay
Diabetes supplies:$0 copay
Wellness programs (e.g., fitness, nursing hotline)
Covered
Medicare Part B drugs
Chemotherapy:$0 copay
Other Part B drugs:$0 copay

Coverage Area for Care1st TotalDual (HMO SNP)

StateCalifornia
CountyLos Angeles

Cost Sharing Information

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 offereds15% coinsuranceNot offered
Tier 2: Non-Preferred GenericNot offered15% coinsuranceNot offered
Tier 3: Preferred Brand NameNot offered15% coinsuranceNot offered
Tier 4: Non-Preferred Brand NameNot offered15% coinsuranceNot offered
Tier 5: Specialty TierNot offered15% coinsuranceNot offered
90 Day SupplyPreferred Retail PharmaciesNon-Preferred Retail PharmaciesMail-Order Pharmacies
Tier 1: Preferred GenericNot offered15% coinsuranceNot offered
Tier 2: Non-Preferred GenericNot offered15% coinsuranceNot offered
Tier 3: Preferred Brand NameNot offered15% coinsuranceNot offered
Tier 4: Non-Preferred Brand NameNot offered15% coinsuranceNot offered
Tier 5: Specialty TierNot offered15% coinsuranceNot offered

CMS Ratings

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 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 fracture
Diabetes care – eye exam
Diabetes care – kidney disease monitoring
Diabetes care – blood sugar controlled
Controlling blood pressure
Rheumatoid arthritis management
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 plan
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

Physician Finder

Physicians that accept Care1st TotalDual (HMO SNP) for California

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