2018 GuildNet Gold Plus FIDA Plan POS (Medicare-Medicaid Plan) H0811-1-0 in NY from GuildNet | HealthPocket

GuildNet Gold Plus FIDA POS (Medicare-Medicaid )

Medicare Advantage Plan for New York

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PARTCRX

Plan Summary

Insurance TypeMedicare Advantage Plan (Part C w/ RX)
Insurance ProviderGuildNet
Plan IDH0811-1-0
CMS RatingNot Rated1
Plan TypeMedicare-Medicaid Plan
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
  • has no additional premium costs outside of your Medicare Part B premium

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)
Not Applicable
Other health plan deductibles?
No
Health Plan Deductible
$0
Monthly Drug Plan Premium
$0.00
Monthly Health Plan Premium
$0.00

Benefits

Service
Cost
Inpatient hospital coverage
In-Network:
$0 copay
Out-of-Network:
$0 copay
Outpatient hospital coverage
In-Network:
$0 copay
Out-of-Network:
$0 copay
Doctor visits
Primary:
In-Network:
$0 copay
Out-of-Network:
$0 copay
Specialist:
In-Network:
$0 copay
Out-of-Network:
$0 copay
Preventive care
In-Network:
$0 copay
Out-of-Network:
$0 copay
Emergency care/Urgent care
Emergency:
$0 copay
Urgent care:
$0 copay
Diagnostic procedures/lab services/imaging
Diagnostic tests and procedures:
In-Network:
$0 copay
Out-of-Network:
$0 copay
Lab services:
In-Network:
$0 copay
Out-of-Network:
$0 copay
Diagnostic radiology services (e.g., MRI):
In-Network:
$0 copay
Out-of-Network:
$0 copay
Outpatient x-rays:
In-Network:
$0 copay
Out-of-Network:
$0 copay
Mental health services
In-Network:
$0 copay
Out-of-Network:
$0 copay
Outpatient group therapy visit with a psychiatrist:
In-Network:
$0 copay
Out-of-Network:
$0 copay
Outpatient individual therapy visit with a psychiatrist:
In-Network:
$0 copay
Out-of-Network:
$0 copay
Outpatient group therapy visit:
In-Network:
$0 copay
Out-of-Network:
$0 copay
Outpatient individual therapy visit:
In-Network:
$0 copay
Out-of-Network:
$0 copay
Skilled Nursing Facility
In-Network:
$0 copay
Out-of-Network:
$0 copay
Rehabilitation services
Occupational therapy visit:
In-Network:
$0 copay
Out-of-Network:
$0 copay
Physical therapy and speech and language therapy visit:
In-Network:
$0 copay
Out-of-Network:
$0 copay
Ambulance
In-Network:
$0 copay
Out-of-Network:
$0 copay
Transportation
In-Network:
$0 copay
Foot care (podiatry services)
Foot exams and treatment:
In-Network:
$0 copay
Out-of-Network:
$0 copay
Routine foot care:
In-Network:
$0 copay
Medical equipment/supplies
Durable medical equipment (e.g., wheelchairs, oxygen):
In-Network:
$0 copay
Out-of-Network:
$0 copay
Prosthetics (e.g., braces, artificial limbs):
In-Network:
$0 copay
Out-of-Network:
$0 copay
Diabetes supplies:
In-Network:
$0 copay
Out-of-Network:
$0 copay
Wellness programs (e.g., fitness, nursing hotline)
Covered
Medicare Part B drugs
Chemotherapy:
In-Network:
$0 copay
Other Part B drugs:
In-Network:
$0 copay

Coverage Area for GuildNet Gold Plus FIDA POS (Medicare-Medicaid )

StateNew York
CountyKings

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 GenericNot offereds0% coinsuranceNot offered
Tier 2: Non-Preferred GenericNot offered0% coinsuranceNot offered
Tier 3: Preferred Brand NameNot offered0% coinsuranceNot offered
Tier 4: Non-Preferred Brand NameNot offered0% coinsuranceNot offered
Tier 5: Specialty Tier
90 Day SupplyPreferred Retail PharmaciesNon-Preferred Retail PharmaciesMail-Order Pharmacies
Tier 1: Preferred GenericNot offered0% coinsuranceNot offered
Tier 2: Non-Preferred GenericNot offered0% coinsuranceNot offered
Tier 3: Preferred Brand NameNot offered0% coinsuranceNot offered
Tier 4: Non-Preferred Brand NameNot offered0% coinsuranceNot offered
Tier 5: Specialty Tier

Physician Finder

Physicians that accept GuildNet Gold Plus FIDA POS (Medicare-Medicaid ) for New York

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