2020 MMM ELITE (HMO) H3293-2-0 in FL from MMM of Florida, Inc. | HealthPocket

MMM ELITE (HMO)

$0/mo

Benefits & Coverage

Insurance TypeMedicare Advantage Plan (Part C w/ RX)
Insurance ProviderMMM of Florida, Inc.
Plan IDH3293-2-0
Plan Year2020
CMS RatingNot Rated
Plan TypeHMO
Annual Deductible$0.00
Out-of-Pocket Maximum3400

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$0.00
Estimated yearly costs
Estimated total yearly costs for care$2,874.00
Out-of-pocket max
Out-of-pocket max$3,400 In-network

Benefits & costs

Doctor services
Primary doctor visit$0 copay
Specialist visit$10 per visit
Tests, labs, & imaging
Diagnostic tests & procedures$0-25
Lab services$0 copay
Diagnostic radiology services (like MRI)$0-100
Outpatient x-rays$0-20
Emergency care$55 per visit (always covered)
Urgent care$0 copay
Hospital services
Inpatient hospital coverage$0 copay
Outpatient hospital coverage$100 per visit
Skilled nursing facility
Skilled nursing facility$0 per day for days 1 through 20
$100 per day for days 21 through 100
Preventive services
Preventive services$0 copay
Ambulance
Ground ambulance$175
Therapy services
Occupational therapy visit$10
Physical therapy & speech & language therapy visit$0-10
Mental health services
Outpatient group therapy with a psychiatrist$10
Outpatient individual therapy with a psychiatrist$10
Outpatient group therapy visit$10
Outpatient individual therapy visit$10
Opioid treatment services
Opioid treatment servicesCovered
Other services
Durable medical equipment (like wheelchairs & oxygen)0-20% per item
Prosthetics (like braces, artificial limbs)$0 copay
Diabetes supplies0-20% per item

Extra benefits & costs

Hearing
Hearing exam$0 copay
Fitting/evaluation$0 copay
Hearing aids - All types$0 copay
Preventive dental
Oral exam$0 copay
Cleaning$0 copay
Fluoride treatment$0 copay
Dental x-rays$0 copay
Comprehensive dental
Non-routine servicesNot covered
Diagnostic services$0 copay
Restorative services$0 copay
EndodonticsNot covered
PeriodonticsNot covered
Extractions$0 copay
Prosthodontics, other oral/maxillofacial surgery, other services$0 copay
Vision
Routine eye exam$0 copay
Contact lenses$0 copay
Eyeglasses (frames & lenses)$0 copay
Eyeglass frames (only)Not covered
Eyeglass lenses (only)Not covered
UpgradesNot covered
More benefits
Fitness benefitLimited coverage
Transportation services for non-emergency care: Any health-related locationsNot covered
Transportation services for non-emergency care: Plan-approved locationsLimited coverage
Over the counter drug benefitsLimited coverage
In-home support servicesNot covered
Routine chiropractic serviceLimited coverage
Home and bathroom safety devicesNot covered
Meals for short durationLimited coverage
Annual physical examsNot covered
TelehealthNot covered

Drug coverage & costs

Part B drugs
Chemotherapy drugs20%
Other Part B drugs0-20%

Coverage Area for MMM ELITE (HMO)

StateFlorida
CountyMiami-Dade

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$0 copayNot offeredNot offered
Tier 2: Non-Preferred GenericNot offereds$0 copayNot offeredNot offered
Tier 3: Preferred Brand NameNot offereds$20 copayNot offeredNot offered
Tier 4: Non-Preferred Brand NameNot offereds$75 copayNot offeredNot offered
Tier 5: Specialty TierNot offereds33% coinsuranceNot offeredNot offered
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$0 copayNot offered$0 copay
Tier 3: Preferred Brand NameNot offereds$60 copayNot offered$60 copay
Tier 4: Non-Preferred Brand NameNot offereds$225 copayNot offered$225 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

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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).

Medicare Plans Found

 

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).