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

GuildNet Gold Plus FIDA Plan POS (Medicare-Medicaid Plan)

$0/mo

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Zip Code11226
Applicant10/19/1983 Male
Coverage Start10/20/2018
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Benefits & Coverage

Insurance TypeMedicare Advantage Plan (Part C w/ RX)
Insurance ProviderGuildNet
Plan IDH0811-1-0
Plan Year2018
CMS RatingNot Rated
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

Costs and Other Important Information

Plan Year2018
Optional Supplemental BenefitsNo
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

SERVICECOST
Inpatient hospital coverageIn-Network:
$0 copay
Out-of-Network:
$0 copay
Outpatient hospital coverageIn-Network:
$0 copay
Out-of-Network:
$0 copay
Doctor visitsPrimary:
In-Network:
$0 copay
Out-of-Network:
$0 copay
Specialist:
In-Network:
$0 copay
Out-of-Network:
$0 copay
Preventive careIn-Network:
$0 copay
Out-of-Network:
$0 copay
Emergency care/Urgent careEmergency:
$0 copay
Urgent care:
$0 copay
Diagnostic procedures/lab services/imagingDiagnostic 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 servicesIn-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 FacilityIn-Network:
$0 copay
Out-of-Network:
$0 copay
Rehabilitation servicesOccupational 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
AmbulanceIn-Network:
$0 copay
Out-of-Network:
$0 copay
TransportationIn-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/suppliesDurable 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 drugsChemotherapy:
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

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

60 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
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

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

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