2018 MetroPlus Platinum (HMO) H0423-4-0 in NY from MetroPlus | HealthPocket

MetroPlus Platinum (HMO)

Medicare Advantage Plan for New York

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PARTCRX

Plan Summary

Insurance TypeMedicare Advantage Plan (Part C w/ RX)
Insurance ProviderMetroPlus
Plan IDH0423-4-0
CMS Rating1
Plan TypeHMO
Annual Deductible$405.00

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)
$6,700 In-network
Other health plan deductibles?
No
Health Plan Deductible
$0
Monthly Drug Plan Premium
$57.30
Monthly Health Plan Premium
$196.90

Benefits

Service
Cost
Inpatient hospital coverage
$225 for days 1 through 8
$0 for days 9 through 90
Outpatient hospital coverage
20% per visit
Doctor visits
Primary:
$0 copay
Specialist:
$40 per visit
Preventive care
$0 copay
Emergency care/Urgent care
Emergency:
$75 per visit (always covered)
Urgent care:
$0 copay
Diagnostic procedures/lab services/imaging
Diagnostic tests and procedures:
20%
Lab services:
20%
Diagnostic radiology services (e.g., MRI):
20%
Outpatient x-rays:
20%
Mental health services
$195 for days 1 through 8
$0 for days 9 through 90
Outpatient group therapy visit with a psychiatrist:
$40
Outpatient individual therapy visit with a psychiatrist:
$40
Outpatient group therapy visit:
$40
Outpatient individual therapy visit:
$40
Skilled Nursing Facility
Coming soon
Rehabilitation services
Occupational therapy visit:
$25
Physical therapy and speech and language therapy visit:
$25
Ambulance
$100
Transportation
Not covered
Foot care (podiatry services)
Foot exams and treatment:
$30
Routine foot care:
Not covered
Medical equipment/supplies
Durable medical equipment (e.g., wheelchairs, oxygen):
20% per item
Prosthetics (e.g., braces, artificial limbs):
20% per item
Diabetes supplies:
20% per item
Wellness programs (e.g., fitness, nursing hotline)
Not covered
Medicare Part B drugs
Chemotherapy:
20%
Other Part B drugs:
20%

Coverage Area for MetroPlus Platinum (HMO)

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 offereds25% coinsuranceNot 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 offered25% coinsuranceNot offered
Tier 2: Non-Preferred Generic
Tier 3: Preferred Brand Name
Tier 4: Non-Preferred Brand Name
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
Care for older adults – medication review
Care for older adults – functional status assessment
Care for older adults – Pain screening
Osteoporosis management in women who had a fracture
Not Rated
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
Not Rated

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 MetroPlus Platinum (HMO) for New York

/
Perez, Walter
2146 Beverley Rd
Brooklyn, NY 11226
Good Health Medical Of Brooklyn, P.c.
2026 Ocean Ave
Brooklyn, NY 11230
Umheiser, Edward
325 Garfield Pl
Brooklyn, NY 11215
Sher, Lawrence
2414 Kings Hwy
Brooklyn, NY 11229
Krupitsky, Victor
2467 Ocean Ave
Brooklyn, NY 11229
Zaidi, Ali
76 Broadway
Brooklyn, NY 11206
Hon, John
831 56th St
Brooklyn, NY 11220
Dvoskin, Dmitriy
8686 Bay Pkwy Ste M4
Brooklyn, NY 11214
Corre, Vanessa May
7117 11th Ave
Brooklyn, NY 11228
Specialty Anesthesia Interventions, Pc
129 Saint Nicholas Ave
Brooklyn, NY 11237
Details
Walter Perez, D.P.M.
Phone Number
(718) 675-1717
Office Locations
2146 Beverley Rd
Brooklyn, NY 11226
2146 Beverley Rd Brooklyn NY, 11226

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