2018 Medicare HMO Blue FlexRx (HMO-POS) H2261-23-1 in MA from Blue Cross Blue Shield of Massachusetts | HealthPocket

Medicare HMO Blue FlexRx (HMO-POS)

Medicare Advantage Plan for Massachusetts

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PARTCRX

Plan Summary

Insurance TypeMedicare Advantage Plan (Part C w/ RX)
Insurance ProviderBlue Cross Blue Shield of Massachusetts
Plan IDH2261-23-1
CMS Rating1
Plan TypeHMO-POS
Annual Deductible$260.00

What To Know About This Plan

  • This plan has health and drug coverage

Why We Like This Plan

  • has both Health and Drug Coverage
  • has a copay of $1 for Tier 1 preferred generic drugs (30 day supply, preferred retail pharmacies)

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)
$3,900 In-network $9,900 Out-of-network
Other health plan deductibles?
No
Health Plan Deductible
$0
Monthly Drug Plan Premium
$33.10
Monthly Health Plan Premium
$62.90

Benefits

Service
Cost
Inpatient hospital coverage
In-Network:
$200 for days 1 through 5
$0 for days 6 through 90
$0 for days 91 and beyond
Out-of-Network:
20% per stay
Outpatient hospital coverage
In-Network:
$200 per visit
Out-of-Network:
20% per visit
Doctor visits
Primary:
In-Network:
$15 per visit
Out-of-Network:
$65 per visit
Specialist:
In-Network:
$35 per visit
Out-of-Network:
$65 per visit
Preventive care
In-Network:
$0 copay
Out-of-Network:
$65 or 20%
Emergency care/Urgent care
Emergency:
$75 per visit (always covered)
Urgent care:
$15-65 per visit (always covered)
Diagnostic procedures/lab services/imaging
Diagnostic tests and procedures:
In-Network:
$15
Out-of-Network:
20%
Lab services:
In-Network:
$15
Out-of-Network:
20%
Diagnostic radiology services (e.g., MRI):
In-Network:
$200
Out-of-Network:
40%
Outpatient x-rays:
In-Network:
$15
Out-of-Network:
20%
Mental health services
In-Network:
$200 for days 1 through 5
$0 for days 6 through 90
$0 for days 91 and beyond
Out-of-Network:
20% per stay
Outpatient group therapy visit with a psychiatrist:
In-Network:
$35
Out-of-Network:
20%
Outpatient individual therapy visit with a psychiatrist:
In-Network:
$35
Out-of-Network:
20%
Outpatient group therapy visit:
In-Network:
$35
Out-of-Network:
20%
Outpatient individual therapy visit:
In-Network:
$35
Out-of-Network:
20%
Skilled Nursing Facility
In-Network:
$0 for days 1 through 20
$140 for days 21 through 44
$0 for days 45 through 100
Out-of-Network:
20% per stay
Rehabilitation services
Occupational therapy visit:
In-Network:
$15
Out-of-Network:
20%
Physical therapy and speech and language therapy visit:
In-Network:
$15
Out-of-Network:
20%
Ambulance
In-Network:
$100
Out-of-Network:
$100
Transportation
Not covered
Foot care (podiatry services)
Foot exams and treatment:
In-Network:
$15-35
Out-of-Network:
$65
Routine foot care:
Not covered
Medical equipment/supplies
Durable medical equipment (e.g., wheelchairs, oxygen):
In-Network:
10% per item
Out-of-Network:
20% per item
Prosthetics (e.g., braces, artificial limbs):
In-Network:
10% per item
Out-of-Network:
20% per item
Diabetes supplies:
In-Network:
$0 copay
Out-of-Network:
20% per item
Wellness programs (e.g., fitness, nursing hotline)
Covered
Medicare Part B drugs
Chemotherapy:
In-Network:
10%
Out-of-Network:
10%
Other Part B drugs:
In-Network:
10%
Out-of-Network:
10%

Coverage Area for Medicare HMO Blue FlexRx (HMO-POS)

StateMassachusetts
CountySuffolk

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 Generic$1 copay$6 copayNot offered
Tier 2: Non-Preferred Generic$5 copay$10 copayNot offered
Tier 3: Preferred Brand Name$42 copay$47 copayNot offered
Tier 4: Non-Preferred Brand Name$95 copay$100 copayNot offered
Tier 5: Specialty Tier26% coinsurance26% coinsuranceNot offered
90 Day SupplyPreferred Retail PharmaciesNon-Preferred Retail PharmaciesMail-Order Pharmacies
Tier 1: Preferred Generic$3 copay$18 copayNot offered
Tier 2: Non-Preferred Generic$15 copay$30 copayNot offered
Tier 3: Preferred Brand Name$126 copay$141 copayNot offered
Tier 4: Non-Preferred Brand Name$285 copay$300 copayNot offered
Tier 5: Specialty Tier26% coinsurance26% coinsuranceNot offered

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
Not Rated
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

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 Medicare HMO Blue FlexRx (HMO-POS) for Massachusetts

/
SILVA, CATHERINE
10 GOVE ST
EAST BOSTON, MA 02128
MOTT KEIS, RACHEL
10 GOVE ST
EAST BOSTON, MA 02128
BENTLEY, MARI
10 GOVE ST
EAST BOSTON, MA 02128
MEHRA, ANU
10 GOVE ST
EAST BOSTON, MA 02128
PIERCE, EILEEN
10 GOVE ST
EAST BOSTON, MA 02128
DABORA, SANDRA
10 GOVE ST
EAST BOSTON, MA 02128
BLEVINS, PENGWYNNE
10 GOVE ST
EAST BOSTON, MA 02128
DOHLMAN, JAN
10 GOVE ST
EAST BOSTON, MA 02128
CARDENAS, LILIA
10 GOVE ST
EAST BOSTON, MA 02128
CHEN, DOROTHY
10 GOVE ST
EAST BOSTON, MA 02128
CHUA, MARGARETH
10 GOVE ST
EAST BOSTON, MA 02128
KOSTICH, MIRJANA
10 GOVE ST
EAST BOSTON, MA 02128
SCHAPIRO, JEFFREY
10 GOVE ST
EAST BOSTON, MA 02128
HUTNER, ALINE
10 GOVE ST
EAST BOSTON, MA 02128
HELLER, CHARMALIE
10 GOVE ST
EAST BOSTON, MA 02128
MANANDHAR, MONICA
10 GOVE ST
EAST BOSTON, MA 02128
KUEBLER, FRANCES
10 GOVE ST
EAST BOSTON, MA 02128
BROWN, ALLISON
10 GOVE ST
EAST BOSTON, MA 02128
HAZARIKA, RAJNEESH
10 GOVE ST
EAST BOSTON, MA 02128
LAMBL, BARBARA
10 GOVE ST
EAST BOSTON, MA 02128
CHOU, LORETTA
10 GOVE ST
EAST BOSTON, MA 02128
RANEY, JENNIFER
10 GOVE ST
EAST BOSTON, MA 02128
OAKLAND, MARGARET
10 GOVE ST
EAST BOSTON, MA 02128
ZARRAGA-FORSYTH, IDA
10 GOVE ST
EAST BOSTON, MA 02128
Details
CATHERINE SILVA, M.D.
Phone Number
(617) 569-5800
Office Locations
10 GOVE ST
EAST BOSTON, MA 02128
10 GOVE ST EAST BOSTON MA, 02128

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