2020 Medica Advantage Solution with CHI Health (HMO) H0798-1-0 in IA from Medical Associates | HealthPocket

Medica Advantage Solution with CHI Health (HMO)

$0/mo

Benefits & Coverage

Insurance TypeMedicare Advantage Plan (Part C w/ RX)
Insurance ProviderMedical Associates
Plan IDH0798-1-0
Plan Year2020
CMS RatingNot Rated
Plan TypeHMO
Annual Deductible$350.00
Out-of-Pocket Maximum3500

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
  • has a copay of $0 for Tier 1 preferred generic drugs (30 day supply, preferred retail pharmacies)

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$350.00
Estimated yearly costs
Estimated total yearly costs for care$4,086.00
Out-of-pocket max
Out-of-pocket max$3,500 In-network

Benefits & costs

Doctor services
Primary doctor visit$0 copay
Specialist visit$50 per visit
Tests, labs, & imaging
Diagnostic tests & procedures20%
Lab services$0 copay
Diagnostic radiology services (like MRI)20%
Outpatient x-rays20%
Emergency care$90 per visit (always covered)
Urgent care$20-50 per visit (always covered)
Hospital services
Inpatient hospital coverage$350 per day for days 1 through 5
$0 per day for days 6 through 90
Outpatient hospital coverage$295 per visit
Skilled nursing facility
Skilled nursing facility$0 per day for days 1 through 20
$178 per day for days 21 through 100
Preventive services
Preventive services$0 copay
Ambulance
Ground ambulance$200
Therapy services
Occupational therapy visit$40
Physical therapy & speech & language therapy visit$40
Mental health services
Outpatient group therapy with a psychiatrist$40
Outpatient individual therapy with a psychiatrist$40
Outpatient group therapy visit$40
Outpatient individual therapy visit$40
Opioid treatment services
Opioid treatment servicesCovered
Other services
Durable medical equipment (like wheelchairs & oxygen)20% per item
Prosthetics (like braces, artificial limbs)20% per item
Diabetes supplies20% per item

Extra benefits & costs

Hearing
Hearing exam$25
Fitting/evaluation$0 copay
Hearing aids - All types$599-899
Preventive dental
Oral exam$0 copay
Cleaning$0 copay
Fluoride treatment$0 copay
Dental x-rays$0 copay
Comprehensive dental
Non-routine services$0 copay
Diagnostic services$0 copay
Restorative services$0 copay
Endodontics$0 copay
Periodontics$0 copay
Extractions$0 copay
Prosthodontics, other oral/maxillofacial surgery, other services$0 copay
Vision
Routine eye exam$35
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
Home and bathroom safety devicesNot covered
Meals for short durationLimited coverage
Annual physical examsLimited coverage
TelehealthLimited coverage

Drug coverage & costs

Part B drugs
Chemotherapy drugs20%
Other Part B drugs20%

Coverage Area for Medica Advantage Solution with CHI Health (HMO)

StateIowa
CountyPolk

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 Generic$0 copay$10 copayNot offeredNot offered
Tier 2: Non-Preferred Generic$10 copay$20 copayNot offeredNot offered
Tier 3: Preferred Brand Name$47 copay$47 copayNot offeredNot offered
Tier 4: Non-Preferred Brand Name50% coinsurance50% coinsuranceNot offeredNot offered
Tier 5: Specialty Tier26% coinsurance26% coinsuranceNot offered26% 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 Generic$0 copay$30 copayNot offered$0 copay
Tier 2: Non-Preferred Generic$30 copay$60 copayNot offered$20 copay
Tier 3: Preferred Brand Name$141 copay$141 copayNot offered$131 copay
Tier 4: Non-Preferred Brand Name50% coinsurance50% coinsuranceNot offered50% coinsurance
Tier 5: Specialty Tier
Tier 6: Select Care Drugs

Physicians that accept Medica Advantage Solution with CHI Health (HMO) for Iowa

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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).