2020 Clear Spring Health Essential (PPO) H2020-1-0 in CO from Clear Spring Health | HealthPocket

Clear Spring Health Essential (PPO)

$0/mo

Benefits & Coverage

Insurance TypeMedicare Advantage Plan (Part C w/ RX)
Insurance ProviderClear Spring Health
Plan IDH2020-1-0
Plan Year2020
CMS RatingNot Rated
Plan TypePPO
Annual Deductible$95.00
Out-of-Pocket Maximum5500

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

Overview

Premium
Total monthly premium$0.00
Health plan premium$0.00
Drug plan premium$0.00
Standard Part B premium$135.50
Part B premium reductionNo
Deductible
Health plan deductible$0
Drug plan deductible$95.00
Estimated yearly costs
Estimated total yearly costs for care$3,846.00
Out-of-pocket max
Out-of-pocket max$10,000 In and Out-of-network
$5,500 In-network

Benefits & costs

Doctor services
Primary doctor visitIn-network: $10 per visit
Out-of-network: 45% per visit
Specialist visitIn-network: $45 per visit
Out-of-network: 45% per visit
Tests, labs, & imaging
Diagnostic tests & proceduresIn-network: $0 copay
Out-of-network: 45%
Lab servicesIn-network: $0 copay
Out-of-network: 45%
Diagnostic radiology services (like MRI)In-network: $20-175
Out-of-network: 45%
Outpatient x-raysIn-network: $35
Out-of-network: 45%
Emergency care$90 per visit (always covered)
Urgent care$30 per visit (always covered)
Hospital services
Inpatient hospital coverageIn-network: $320 per day for days 1 through 5
$0 per day for days 6 through 90
Out-of-network: 45% per day for days 1 through 5
45% per day for days 6 through 90
Outpatient hospital coverageIn-network: $45-340 per visit
Out-of-network: 45% per visit
Skilled nursing facility
Skilled nursing facilityIn-network: $0 per day for days 1 through 20
$178 per day for days 21 through 100
Out-of-network: 45% per day for days 1 through 20
45% per day for days 21 through 100
Preventive services
Preventive servicesIn-network: $0 copay
Out-of-network: 45%
Ambulance
Ground ambulanceIn-network: $275
Out-of-network: $275
Therapy services
Occupational therapy visitIn-network: $40
Out-of-network: 45%
Physical therapy & speech & language therapy visitIn-network: $40
Out-of-network: 45%
Mental health services
Outpatient group therapy with a psychiatristIn-network: $40
Out-of-network: 45%
Outpatient individual therapy with a psychiatristIn-network: $40
Out-of-network: 45%
Outpatient group therapy visitIn-network: $40
Out-of-network: 45%
Outpatient individual therapy visitIn-network: $40
Out-of-network: 45%
Opioid treatment services
Opioid treatment servicesCovered
Other services
Durable medical equipment (like wheelchairs & oxygen)In-network: 20% per item
Out-of-network: 45% per item
Prosthetics (like braces, artificial limbs)In-network: 20% per item
Out-of-network: 45% per item
Diabetes suppliesIn-network: $0 copay
Out-of-network: 20% per item

Extra benefits & costs

Hearing
Hearing examIn-network: $45
Out-of-network: 45%
Fitting/evaluationIn-network: $0 copay
Out-of-network: 100%
Hearing aids - All typesIn-network: $400
Out-of-network: 100%
Preventive dental
Oral examIn-network: $0 copay
Out-of-network: $0 copay
CleaningIn-network: $0 copay
Out-of-network: $0 copay
Fluoride treatmentIn-network: $0 copay
Out-of-network: $0 copay
Dental x-raysIn-network: $0 copay
Out-of-network: $0 copay
Comprehensive dental
Non-routine servicesIn-network: $0 copay
Out-of-network: $0 copay
Diagnostic servicesIn-network: $0 copay
Out-of-network: $0 copay
Restorative servicesIn-network: $0 copay
Out-of-network: $0 copay
EndodonticsIn-network: $0 copay
Out-of-network: $0 copay
PeriodonticsIn-network: $0 copay
Out-of-network: $0 copay
ExtractionsIn-network: $0 copay
Out-of-network: $0 copay
Prosthodontics, other oral/maxillofacial surgery, other servicesIn-network: $0 copay
Out-of-network: $0 copay
Vision
Routine eye examIn-network: $0 copay
Out-of-network: 100%
Contact lensesNot covered
Eyeglasses (frames & lenses)In-network: $0 copay
Out-of-network: 100%
Eyeglass frames (only)Not covered
Eyeglass lenses (only)Not covered
UpgradesNot covered
More benefits
Fitness benefitLimited coverage
Over the counter drug benefitsNot covered
In-home support servicesNot covered
Home and bathroom safety devicesNot covered
Meals for short durationNot covered
Annual physical examsLimited coverage
TelehealthLimited coverage

Drug coverage & costs

Part B drugs
Chemotherapy drugsIn-network: 20%
Out-of-network: 45%
Other Part B drugsIn-network: 20%
Out-of-network: 45%

Coverage Area for Clear Spring Health Essential (PPO)

StateColorado
CountyDenver

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


30 Day SupplyPreferred Retail Pharmacies Drug CostStandard Retail Pharmacies Drug CostPreferred Mail-Order Drug CostStandard Mail-Order Drug Cost
Tier 1: Preferred GenericNot offereds$2 copayNot offered$2 copay
Tier 2: Non-Preferred GenericNot offereds$7 copayNot offered$7 copay
Tier 3: Preferred Brand NameNot offereds$47 copayNot offered$47 copay
Tier 4: Non-Preferred Brand NameNot offereds$100 copayNot offered$100 copay
Tier 5: Specialty TierNot offereds31% coinsuranceNot offered31% coinsurance
Tier 6: Select Care Drugs

90 Day SupplyPreferred Retail Pharmacies Drug CostStandard Retail Pharmacies Drug CostPreferred Mail-Order Drug CostStandard Mail-Order Drug Cost
Tier 1: Preferred GenericNot offereds$0 copayNot offered$0 copay
Tier 2: Non-Preferred GenericNot offereds$21 copayNot offered$16 copay
Tier 3: Preferred Brand NameNot offereds$141 copayNot offered$136 copay
Tier 4: Non-Preferred Brand NameNot offereds$300 copayNot offered$300 copay
Tier 5: Specialty Tier
Tier 6: Select Care Drugs

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 managementNot Rated
Care for older adults – medication reviewNot Rated
Care for older adults – functional status assessmentNot Rated
Care for older adults – Pain assessmentNot Rated
Osteoporosis management in women who had a fractureNot Rated
Diabetes care – eye examNot Rated
Diabetes care – kidney disease monitoringNot Rated
Diabetes care – blood sugar controlledNot Rated
Rheumatoid arthritis managementNot Rated
Reducing the risk of fallingNot Rated
Improving bladder controlNot Rated
Medication reconciliation post-dischargeNot Rated
Plan all-cause readmissionsNot Rated
Statin Therapy for Patients with Cardiovascular DiseaseNot Rated

Member Experience with Health Plan

Getting needed careNot Rated
Getting appointments and care quicklyNot Rated
Customer serviceNot Rated
Rating of health care qualityNot Rated
Rating of health 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
Health plan quality improvementNot Rated

Health Plan Customer Service

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

Drug Plan Customer Service

Call center – foreign language interpreter and TTY availability
Appeals auto-forwardNot Rated
Appeals upheldNot Rated

Member Complaints, and Changes in Drug Plan's Performance

Complaints about the drug planNot Rated
Members choosing to leave the drug planNot Rated
Drug plan quality improvementNot Rated

Member Experience with Drug Plan

Rating of drug planNot Rated
Getting needed prescription drugsNot Rated

Drug Pricing and Patient Safety

MPF Price AccuracyNot Rated
Medication adherence for diabetes medicationsNot Rated
Medication adherence for hypertension - RAS antagonistsNot Rated
Medication adherence for cholesterol - StatinsNot Rated
MTM program completion rate for CMRNot Rated
Statin use in persons with diabetes - SUPDNot Rated

Physicians that accept Clear Spring Health Essential (PPO) for Colorado

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Medicare Plans Found

 

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HealthPocket is a free information source designed to help consumers find medical coverage. Whether you are looking for Medicare, or an individual and family 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 part of the Health Insurance Innovations, Inc. family of companies (NASDAQ: HIIQ).