Molina Medicare Options Plus (HMO SNP)

Medicare Advantage Plan for Florida

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PARTCRX

Plan Summary

Insurance TypeMedicare Advantage Plan (Part C w/ RX)
Insurance ProviderMolina Healthcare
Plan IDH8130-1-0
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

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
Coming soon
Monthly Drug Plan Premium
$29.10
Monthly Health Plan Premium
$0.00

Benefits

Service
Cost
Inpatient hospital coverage
Coming soon
Outpatient hospital coverage
0% or 20% per visit
Doctor visits
Primary:
0% or 20% per visit
Specialist:
0% or 20% per visit
Preventive care
$0 copay
Emergency care/Urgent care
Emergency:
0% or 20% per visit (always covered)
Urgent care:
0% or 20% per visit (always covered)
Diagnostic procedures/lab services/imaging
Diagnostic tests and procedures:
0% or 20%
Lab services:
$0 copay
Diagnostic radiology services (e.g., MRI):
0% or 20%
Outpatient x-rays:
0% or 20%
Mental health services
Coming soon
Outpatient group therapy visit with a psychiatrist:
0% or 20%
Outpatient individual therapy visit with a psychiatrist:
0% or 20%
Outpatient group therapy visit:
0% or 20%
Outpatient individual therapy visit:
0% or 20%
Skilled Nursing Facility
Coming soon
Rehabilitation services
Occupational therapy visit:
0% or 20%
Physical therapy and speech and language therapy visit:
0% or 20%
Ambulance
0% or 20%
Transportation
$0 copay
Foot care (podiatry services)
Foot exams and treatment:
0% or 20%
Routine foot care:
$0 copay
Medical equipment/supplies
Durable medical equipment (e.g., wheelchairs, oxygen):
0% or 20% per item
Prosthetics (e.g., braces, artificial limbs):
0% or 20% per item
Diabetes supplies:
$0 copay
Wellness programs (e.g., fitness, nursing hotline)
Covered
Medicare Part B drugs
Chemotherapy:
0% or 20%
Other Part B drugs:
0% or 20%

Coverage Area for Molina Medicare Options Plus (HMO SNP)

StateFlorida
CountyMiami-Dade

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 offereds$0 copayNot offered
Tier 2: Non-Preferred GenericNot offered$0 copayNot offered
Tier 3: Preferred Brand NameNot offered$47 copayNot offered
Tier 4: Non-Preferred Brand NameNot offered47% coinsuranceNot offered
Tier 5: Specialty TierNot offered25% 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$0 copayNot offered
Tier 3: Preferred Brand NameNot offered$141 copayNot offered
Tier 4: Non-Preferred Brand NameNot offered47% coinsuranceNot offered
Tier 5: Specialty Tier

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
Not Rated
Diabetes care – eye exam
Diabetes care – kidney disease monitoring
Diabetes care – blood sugar controlled
Controlling blood pressure
Rheumatoid arthritis management
Not Rated
Reducing the risk of falling
Plan all-cause readmissions
Not Rated

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
Not 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

Physician Finder

Physicians that accept Molina Medicare Options Plus (HMO SNP) for Florida

/
ROJAS, ROMEO
12002 SW 128TH CT STE 204
MIAMI, FL 33186
PANDO, JARY
13001 SW 88TH ST
MIAMI, FL 33186
HERNANDEZ, OSCAR
14221 SW 120TH ST
MIAMI, FL 33186
NUNEZ, RIGOBERTO
8900 SW 117TH AVE
MIAMI, FL 33186
CINTAS, MAURA
9000 SW 137TH AVE
MIAMI, FL 33186
ALBITES, FRANCISCO
9000 SW 137TH AVE
MIAMI, FL 33186
PENATE, ROLANDO
6963 SW 117TH AVE
MIAMI, FL 33183
GARCIA, NELSON
8200 SW 117TH AVE STE 110
MIAMI, FL 33183
MARTEL, JERRY
8200 SW 117TH AVE
MIAMI, FL 33183
SCHULTZ, ELIZABETH
11731 MILLS DR
MIAMI, FL 33183
HASAN, ANTHONY
8501 SW 124TH AVE STE 112
MIAMI, FL 33183
FANILLA, EDUARDO
6963 SW 117TH AVE
MIAMI, FL 33183
MALAVE-VIDAL, IVAN
8900 N KENDALL DR
MIAMI, FL 33176
ZAMBRANO, JUAN
9380 SW 150TH ST
MIAMI, FL 33176
TU, YEN-TE
8900 N KENDALL DR
MIAMI, FL 33176
EPSTEIN, MELISSA
8900 N KENDALL DR
MIAMI, FL 33176
DAGHISTANI, DOURED
8900 N KENDALL DR
MIAMI, FL 33176
LAMBROU, NICHOLAS
8900 N. KENDALL DR
MIAMI, FL 33176
SKOLNIK, PHYLLIS
8720 NO KENDALL DRIVE
MIAMI, FL 33176
ESCATEL, EVA
8900 N KENDALL DR
MIAMI, FL 33176
REDDY, PRASHANTH
8900 N KENDALL DR
MIAMI, FL 33176
OELTJEN, JOHN
8740 SW 88TH ST
MIAMI, FL 33176
CHENEY, JENNIFER
8900 N. KENDALL DRIVE
MIAMI, FL 33176
SAMPER, GUILLERMO
8900 N KENDALL DR
MIAMI, FL 33176
TSOUKAS, ATHANASSIOS
8950 N KENDALL DR
MIAMI, FL 33176
Details
ROMEO ROJAS, MD
Phone Number
(305) 259-7111
Office Locations
12002 SW 128TH CT STE 204
MIAMI, FL 33186
12002 SW 128TH CT STE 204 MIAMI FL, 33186

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