2018 Kalos Health Gold Plus (HMO SNP) H3227-1-0 in NY from Kalos Health Plan | HealthPocket

Kalos Health Gold Plus (HMO SNP)

$0/mo

Apply For This Plan

Zip Code11226
Applicant10/23/1983 Male
Coverage Start10/24/2018
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Benefits & Coverage

Insurance TypeMedicare Advantage Plan (Part C w/ RX)
Insurance ProviderKalos Health Plan
Plan IDH3227-1-0
Plan Year2018
CMS RatingNot Rated
Plan TypeHMO SNP
Annual Deductible$405.00

What To Know About This Plan
  • This plan has health and drug coverage
  • This plan is available for 2019. see plan

Why We Like This Plan
  • has both Health and Drug Coverage
  • has no additional premium costs outside of your Medicare Part B premium

Costs and Other Important Information

Plan Year2018
Optional Supplemental BenefitsNo
Maximum out-of-pocket enrollee responsibility (does not include prescription drugs)$6,700 In-network
Other health plan deductibles?No
Health Plan Deductible$0
Monthly Drug Plan Premium$0.00
Monthly Health Plan Premium$0.00

Benefits

SERVICECOST
Inpatient hospital coverage$0 copay
Outpatient hospital coverage$0 copay
Doctor visitsPrimary:
$0 copay
Specialist:
$0 copay
Preventive care$0 copay
Emergency care/Urgent careEmergency:
$0 copay
Urgent care:
$0 copay
Diagnostic procedures/lab services/imagingDiagnostic tests and procedures:
$0 copay
Lab services:
$0 copay
Diagnostic radiology services (e.g., MRI):
$0 copay
Outpatient x-rays:
$0 copay
Mental health services$0 copay
Outpatient group therapy visit with a psychiatrist:
$0 copay
Outpatient individual therapy visit with a psychiatrist:
$0 copay
Outpatient group therapy visit:
$0 copay
Outpatient individual therapy visit:
$0 copay
Skilled Nursing Facility$0 copay
Rehabilitation servicesOccupational therapy visit:
$0 copay
Physical therapy and speech and language therapy visit:
$0 copay
Ambulance$0 copay
TransportationNot covered
Foot care (podiatry services)Foot exams and treatment:
$0 copay
Routine foot care:
Not covered
Medical equipment/suppliesDurable medical equipment (e.g., wheelchairs, oxygen):
$0 copay
Prosthetics (e.g., braces, artificial limbs):
$0 copay
Diabetes supplies:
$0 copay
Wellness programs (e.g., fitness, nursing hotline)Covered
Medicare Part B drugsChemotherapy:
$0 copay
Other Part B drugs:
$0 copay

Coverage Area for Kalos Health Gold Plus (HMO SNP)

StateNew York
CountyKings

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 Generic
Tier 3: Preferred Brand Name
Tier 4: Non-Preferred Brand Name
Tier 5: Specialty Tier

60 Day SupplyPreferred Retail PharmaciesNon-Preferred Retail PharmaciesMail-Order Pharmacies
Tier 1: Preferred GenericNot offered$0 copayNot offered
Tier 2: Non-Preferred Generic
Tier 3: Preferred Brand Name
Tier 4: Non-Preferred Brand Name
Tier 5: Specialty Tier
90 Day SupplyPreferred Retail PharmaciesNon-Preferred Retail PharmaciesMail-Order Pharmacies
Tier 1: Preferred GenericNot offered$0 copayNot offered
Tier 2: Non-Preferred Generic
Tier 3: Preferred Brand Name
Tier 4: Non-Preferred Brand Name
Tier 5: Specialty Tier

Physicians that accept Kalos Health Gold Plus (HMO SNP) for New York

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