Advantra (HMO-POS)

Medicare Advantage Plan for Missouri

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PARTCRX

Plan Summary

Insurance TypeMedicare Advantage Plan (Part C w/ RX)
Insurance ProviderAetna
Plan IDH2663-31-0
CMS Rating1
Plan TypeHMO-POS
Annual Deductible$0.00

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)
$5,200 In-network
Other health plan deductibles?
No
Health Plan Deductible
$0
Monthly Drug Plan Premium
$26.20
Monthly Health Plan Premium
$9.80

Benefits

Service
Cost
Inpatient hospital coverage
In-Network:
$280 for days 1 through 7
$0 for days 8 through 90
Out-of-Network:
30% per stay
Outpatient hospital coverage
In-Network:
$300 or 20% per visit. Out-of-Network:
30% per visit
Doctor visits
Primary:In-Network:
$25 per visit. Out-of-Network:
30% per visit
Specialist:In-Network:
$50 per visit. Out-of-Network:
30% per visit
Preventive care
In-Network:
$0 copay. Out-of-Network:
0-30%
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:
$125Out-of-Network:
30%
Lab services:In-Network:
$0 copay. Out-of-Network:
30%
Diagnostic radiology services (e.g., MRI):In-Network:
$200-275Out-of-Network:
30%
Outpatient x-rays:In-Network:
$25Out-of-Network:
30%
Mental health services
In-Network:
$1,620 per stay. Out-of-Network:
30% per stay
Outpatient group therapy visit with a psychiatrist:In-Network:
$40Out-of-Network:
30%
Outpatient individual therapy visit with a psychiatrist:In-Network:
$40Out-of-Network:
30%
Outpatient group therapy visit:In-Network:
$40Out-of-Network:
30%
Outpatient individual therapy visit:In-Network:
$40Out-of-Network:
30%
Skilled Nursing Facility
In-Network:
$0 for days 1 through 20
$167 for days 21 through 100
Out-of-Network:
30% per stay
Rehabilitation services
Occupational therapy visit:In-Network:
$40Out-of-Network:
30%
Physical therapy and speech and language therapy visit:In-Network:
$40Out-of-Network:
30%
Ambulance
In-Network:
$250Out-of-Network:
$250
Transportation
Not covered
Foot care (podiatry services)
Foot exams and treatment:In-Network:
$50Out-of-Network:
30%
Routine foot care:In-Network:
$50Out-of-Network:
30%
Medical equipment/supplies
Durable medical equipment (e.g., wheelchairs, oxygen):In-Network:
20% per item. Out-of-Network:
30% per item
Prosthetics (e.g., braces, artificial limbs):In-Network:
20% per item. Out-of-Network:
30% per item
Diabetes supplies:In-Network:
0-20% per item. Out-of-Network:
0-20% per item
Wellness programs (e.g., fitness, nursing hotline)
Covered
Medicare Part B drugs
Chemotherapy:In-Network:
20%Out-of-Network:
30%
Other Part B drugs:In-Network:
20%Out-of-Network:
30%

Coverage Area for Advantra (HMO-POS)

StateMissouri
CountySt. Louis

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$2 copay$10 copay$2 copay
Tier 2: Non-Preferred Generic$5 copay$15 copay$5 copay
Tier 3: Preferred Brand Name$42 copay$47 copay$42 copay
Tier 4: Non-Preferred Brand Name$100 copay$100 copay$100 copay
Tier 5: Specialty Tier33% coinsurance33% coinsurance33% coinsurance
90 Day SupplyPreferred Retail PharmaciesNon-Preferred Retail PharmaciesMail-Order Pharmacies
Tier 1: Preferred Generic$6 copay$30 copay$0 copay
Tier 2: Non-Preferred Generic$15 copay$45 copay$10 copay
Tier 3: Preferred Brand Name$126 copay$141 copay$121 copay
Tier 4: Non-Preferred Brand Name$300 copay$300 copay$300 copay
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
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
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 Advantra (HMO-POS) for Missouri

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FIGURA, MICHAEL
4105 UNION RD
SAINT LOUIS, MO 63129
OJASCASTRO-SALARANO, CHRISTINA
5715 TELEGRAPH RD
SAINT LOUIS, MO 63129
MAMMEN, ALEXANDER
4530 LEMAY FERRY RD
SAINT LOUIS, MO 63129
LAUTER, STEVEN
5201 MID AMERICA PLZ
SAINT LOUIS, MO 63129
OJASCASTRO, ALEJANDRO
5715 TELEGRAPH RD
SAINT LOUIS, MO 63129
SANDHU, HARPARTAP
939 SAJAKEED DR
SAINT LOUIS, MO 63129
OJASCASTRO, VICTORIA
5715 TELEGRAPH RD
SAINT LOUIS, MO 63129
DATTA, SUDIP
639 TANYA COURT DR
SAINT LOUIS, MO 63129
STATEN, STEPHEN
4438 TELEGRAPH RD
SAINT LOUIS, MO 63129
RAJA, FARHEEN
6324 TELEGRAPH RD
SAINT LOUIS, MO 63129
WAGSTAFF, DONNA
4438 TELEGRAPH RD
SAINT LOUIS, MO 63129
GRABOWSKI, ANDREW
4438 TELEGRAPH RD
SAINT LOUIS, MO 63129
BERKIN, SHAWN
5524 TELEGRAPH ROAD
ST LOUIS, MO 63129
SHAH, JAY
5541 TELEGRAPH ROAD
SAINT LOUIS, MO 63129
NICHOLS, STEVEN
10010 KENNERLY RD
SAINT LOUIS, MO 63128
DANG, QUOC
10010 KENNERLY RD
SAINT LOUIS, MO 63128
WEIS, MELISSA
12700 SOUTHFORK RD
SAINT LOUIS, MO 63128
SCULLIN, KRISTEN
12348 OLD TESSON RD
SAINT LOUIS, MO 63128
PERSCHBACHER, JAMES
10012 KENNERLY RD
SAINT LOUIS, MO 63128
MWINTSHI, KABEYA
10004 KENNERLY RD
SAINT LOUIS, MO 63128
CALCATERRA, CURT
5034 GRIFFIN RD
SAINT LOUIS, MO 63128
AHMAD, UMRAAN
10012 KENNERLY RD
SAINT LOUIS, MO 63128
MAJUMDAR, SURAJIT
12700 SOUTHFORK RD
SAINT LOUIS, MO 63128
Details
MICHAEL FIGURA, DPM
Phone Number
(314) 894-3761
Office Locations
4105 UNION RD
SAINT LOUIS, MO 63129
4105 UNION RD SAINT LOUIS MO, 63129

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