| Insurance Type | Medicare Advantage Plan (Part C w/ RX) |
| Insurance Provider | Vantage Health Plan |
| Plan ID | H5576-17-2 |
| Plan Year | 2018 |
| CMS Rating | |
| Plan Type | HMO-POS |
| Annual Deductible | $250.00 |
| What To Know About This Plan |
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| Why We Like This Plan |
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| Plan Year | 2018 |
| Optional Supplemental Benefits | No |
| Maximum out-of-pocket enrollee responsibility (does not include prescription drugs) | $5,500 In-network |
| Other health plan deductibles? | No |
| Health Plan Deductible | $500 Out-of-network |
| Monthly Drug Plan Premium | $50.30 |
| Monthly Health Plan Premium | $8.70 |
| SERVICE | COST |
| Inpatient hospital coverage | In-Network: $325 for days 1 through 5 $0 for days 6 through 90 Out-of-Network: 50% per stay |
| Outpatient hospital coverage | In-Network: $350 per visit Out-of-Network: 50% per visit |
| Doctor visits | Primary: In-Network: $20 or 0-20% per visit Out-of-Network: 50% per visit Specialist: In-Network: $50 or 0-20% per visit Out-of-Network: 50% per visit |
| Preventive care | In-Network: $0 copay Out-of-Network: 50% |
| Emergency care/Urgent care | Emergency: $80 per visit (always covered) Urgent care: $65 per visit (always covered) |
| Diagnostic procedures/lab services/imaging | Diagnostic tests and procedures: In-Network: $350 Out-of-Network: 50% Lab services: In-Network: $0 copay Out-of-Network: 50% Diagnostic radiology services (e.g., MRI): In-Network: $350 Out-of-Network: 50% Outpatient x-rays: In-Network: $350 Out-of-Network: 50% |
| Mental health services | In-Network: $405 for days 1 through 4 $0 for days 5 through 90 Out-of-Network: 50% per stay Outpatient group therapy visit with a psychiatrist: In-Network: $40 Out-of-Network: 50% Outpatient individual therapy visit with a psychiatrist: In-Network: $40 Out-of-Network: 50% Outpatient group therapy visit: In-Network: $40 Out-of-Network: 50% Outpatient individual therapy visit: In-Network: $40 Out-of-Network: 50% |
| Skilled Nursing Facility | In-Network: $0 for days 1 through 20 $167 for days 21 through 100 Out-of-Network: 50% per stay |
| Rehabilitation services | Occupational therapy visit: In-Network: $40 Out-of-Network: 50% Physical therapy and speech and language therapy visit: In-Network: $40 Out-of-Network: 50% |
| Ambulance | In-Network: $250 Out-of-Network: $250 |
| Transportation | In-Network: $0 copay |
| Foot care (podiatry services) | Foot exams and treatment: In-Network: $50 Out-of-Network: 50% Routine foot care: Not covered |
| Medical equipment/supplies | Durable medical equipment (e.g., wheelchairs, oxygen): In-Network: 20% per item Out-of-Network: 50% per item Prosthetics (e.g., braces, artificial limbs): In-Network: 20% per item Out-of-Network: 50% per item Diabetes supplies: In-Network: 0-20% per item Out-of-Network: 50% per item |
| Wellness programs (e.g., fitness, nursing hotline) | Covered |
| Medicare Part B drugs | Chemotherapy: In-Network: 20% Out-of-Network: 50% Other Part B drugs: In-Network: 0-20% Out-of-Network: 50% |
| State | Louisiana |
| County | East Baton Rouge |
All cost-sharing assumes in-network healthcare providers.
Prescription Drug Copay/Coninsurance Details - Initial Coverage Limit
| 30 Day Supply | Preferred Retail Pharmacies | Non-Preferred Retail Pharmacies | Mail-Order Pharmacies |
|---|---|---|---|
| Tier 1: Preferred Generic | Not offereds | $4 copay | $0 copay |
| Tier 2: Non-Preferred Generic | Not offered | $12 copay | Not offered |
| Tier 3: Preferred Brand Name | Not offered | $47 copay | Not offered |
| Tier 4: Non-Preferred Brand Name | Not offered | 25% coinsurance | Not offered |
| Tier 5: Specialty Tier | Not offered | 28% coinsurance | Not offered |
| 90 Day Supply | Preferred Retail Pharmacies | Non-Preferred Retail Pharmacies | Mail-Order Pharmacies |
|---|---|---|---|
| Tier 1: Preferred Generic | Not offered | $12 copay | $0 copay |
| Tier 2: Non-Preferred Generic | Not offered | $36 copay | $36 copay |
| Tier 3: Preferred Brand Name | Not offered | $141 copay | $141 copay |
| Tier 4: Non-Preferred Brand Name | Not offered | 25% coinsurance | 25% coinsurance |
| Tier 5: Specialty Tier |
| 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 |
| Special needs plan care management | |
| Care for older adults – medication review | Not Rated |
| Care for older adults – functional status assessment | Not Rated |
| Care for older adults – Pain screening | Not Rated |
| 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 |
| Getting needed care | |
| Getting appointments and care quickly | |
| Customer service | |
| Overall rating of health care quality | |
| Overall rating of plan | |
| Care Coordination |
| Complaints about the health plan | |
| Members choosing to leave the health plan | |
| Beneficiary access and performance problems | |
| Health plan quality improvement |
| Plan makes timely decision about appeals | |
| Reviewing appeals decisions | |
| Call center – foreign language interpreter and TTY/TDD availability - Medical |
| Call center – foreign language interpreter and TTY/TDD availability - Drugs | |
| Appeals auto-forward | |
| Appeals upheld |
| Complaints about the drug plan | |
| Members choosing to leave the drug plan | Not Rated |
| Beneficiary access and performance problems | |
| Drug plan quality improvement |
| Rating of drug plan | |
| Getting needed prescription drugs |
| 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 |
Physicians that accept AAA0 Vantage STANDARD (HMO-POS) for Louisiana
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HealthPocket is a free information source designed to help consumers find medical coverage. Whether you are looking for Medicare, Medicaid or an individual 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 is a free information source designed to help consumers find medical coverage. Whether you are looking for Medicare, Medicaid or an individual 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.