2018 CareSource Advantage Zero Premium (HMO) H6396-4-0 in OH from CareSource | HealthPocket

CareSource Advantage Zero Premium (HMO)

Medicare Advantage Plan for Ohio

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PARTCRX

Plan Summary

Insurance TypeMedicare Advantage Plan (Part C w/ RX)
Insurance ProviderCareSource
Plan IDH6396-4-0
CMS RatingNot Rated1
Plan TypeHMO
Annual Deductible$250.00

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)
$6,700 In-network
Other health plan deductibles?
No
Health Plan Deductible
$0 In-network
Monthly Drug Plan Premium
$0.00
Monthly Health Plan Premium
$0.00

Benefits

Service
Cost
Inpatient hospital coverage
$350 for days 1 through 5
$0 for days 6 through 90
Outpatient hospital coverage
20% per visit
Doctor visits
Primary:
$9 per visit
Specialist:
$45 per visit
Preventive care
$0 copay
Emergency care/Urgent care
Emergency:
$80 per visit (always covered)
Urgent care:
$45 per visit (always covered)
Diagnostic procedures/lab services/imaging
Diagnostic tests and procedures:
15%
Lab services:
15%
Diagnostic radiology services (e.g., MRI):
$175
Outpatient x-rays:
$50
Mental health services
$320 for days 1 through 5
$0 for days 6 through 90
Outpatient group therapy visit with a psychiatrist:
20%
Outpatient individual therapy visit with a psychiatrist:
20%
Outpatient group therapy visit:
$40
Outpatient individual therapy visit:
$40
Skilled Nursing Facility
$0 for days 1 through 20
$167.50 for days 21 through 100
Rehabilitation services
Occupational therapy visit:
20%
Physical therapy and speech and language therapy visit:
20%
Ambulance
$275
Transportation
Not covered
Foot care (podiatry services)
Foot exams and treatment:
$45
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:
$0 copay
Wellness programs (e.g., fitness, nursing hotline)
Covered
Medicare Part B drugs
Chemotherapy:
20%
Other Part B drugs:
20%

Coverage Area for CareSource Advantage Zero Premium (HMO)

StateOhio
CountyFranklin

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 offereds$6 copayNot offered
Tier 2: Non-Preferred GenericNot offered$15 copayNot offered
Tier 3: Preferred Brand NameNot offered$47 copayNot offered
Tier 4: Non-Preferred Brand NameNot offered$100 copayNot offered
Tier 5: Specialty TierNot offered28% coinsuranceNot offered
90 Day SupplyPreferred Retail PharmaciesNon-Preferred Retail PharmaciesMail-Order Pharmacies
Tier 1: Preferred GenericNot offered$18 copayNot offered
Tier 2: Non-Preferred GenericNot offered$45 copayNot offered
Tier 3: Preferred Brand NameNot offered$141 copayNot offered
Tier 4: Non-Preferred Brand NameNot offered$300 copayNot offered
Tier 5: Specialty Tier

CMS Ratings

Staying healthy - screenings, tests and vaccines

Breast cancer screening
Not Rated
Colorectal cancer screening
Not Rated
Annual flu vaccine
Not Rated
Improving or maintaining physical health
Not Rated
Improving or maintaining mental health
Not Rated
Monitoring physical ability
Not Rated
Adult BMI assessment
Not Rated

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
Not Rated
Diabetes care – eye exam
Not Rated
Diabetes care – kidney disease monitoring
Not Rated
Diabetes care – blood sugar controlled
Not Rated
Controlling blood pressure
Not Rated
Rheumatoid arthritis management
Not Rated
Reducing the risk of falling
Not Rated
Plan all-cause readmissions
Not Rated

Member Experience with Health Plan

Getting needed care
Not Rated
Getting appointments and care quickly
Not Rated
Customer service
Not Rated
Overall rating of health care quality
Not Rated
Overall rating of plan
Not Rated
Care Coordination
Not Rated

Member Complaints, and Changes in Health Plan's Performance

Complaints about the health plan
Not Rated
Members choosing to leave the health plan
Not Rated
Beneficiary access and performance problems
Not Rated
Health plan quality improvement
Not Rated

Health Plan Customer Service

Plan makes timely decision about appeals
Not Rated
Reviewing appeals decisions
Not Rated
Call center – foreign language interpreter and TTY/TDD availability - Medical
Not Rated

Drug Plan Customer Service

Call center – foreign language interpreter and TTY/TDD availability - Drugs
Not Rated
Appeals auto-forward
Appeals upheld

Member Complaints, and Changes in Drug Plan's Performance

Complaints about the drug plan
Not Rated
Members choosing to leave the drug plan
Not Rated
Beneficiary access and performance problems
Not Rated
Drug plan quality improvement
Not Rated

Member Experience with Drug Plan

Rating of drug plan
Not Rated
Getting needed prescription drugs
Not Rated

Drug Pricing and Patient Safety

MPF Price Accuracy
Not Rated
High risk medication
Not Rated
Part D medication adherence for diabetes
Not Rated
Part D medication adherence for hypertension
Not Rated
Part D medication adherence for cholesterol
Not Rated
Medication Therapy Management program completion rate
Not Rated

Physician Finder

Physicians that accept CareSource Advantage Zero Premium (HMO) for Ohio

/
King, Gretzel
104 N Murray Hill Rd
Columbus, OH 43228
Kaufman, Jeffrey
104 N Murray Hill Rd
Columbus, OH 43228
Sresthadatta, Thongchai
5100 W Broad St
Columbus, OH 43228
Hinckley, John
5100 W Broad St
Columbus, OH 43228
Vincent, Karen
5100 W Broad St
Columbus, OH 43228
Jordan, Kevin
5100 W Broad St
Columbus, OH 43228
Fraser, William
5100 W Broad St
Columbus, OH 43228
Cunagin, Kimberly
5100 W Broad St
Columbus, OH 43228
Rybaltowski, Mariusz
5100 W Broad St
Columbus, OH 43228
Parker, Sarah
5100 W Broad St
Columbus, OH 43228
Jones, Bruce
5100 W Broad St
Columbus, OH 43228
Harris, Paul
5193 W Broad St
Columbus, OH 43228
Jones, Paula
5100 W Broad St
Columbus, OH 43228
Casey, John
5100 W Broad St
Columbus, OH 43228
Johnsen, Ronald
5100 W Broad St
Columbus, OH 43228
Bell, Peter
5100 W Broad St
Columbus, OH 43228
Sage, Kevin
5100 W Broad St
Columbus, OH 43228
Lowe, Robert
5100 W Broad St
Columbus, OH 43228
Mceldowney, Thomas
5100 W Broad St
Columbus, OH 43228
Jones, David
5100 W Broad St
Columbus, OH 43228
Foss, Peter
5131 Beacon Hill Rd
Columbus, OH 43228
Kistler, Charles
421 Georgesville Road
Columbus, OH 43228
Topinka, Marcus
5100 W Broad St
Columbus, OH 43228
Siddiqui, Saud
440 Industrial Mile Rd
Columbus, OH 43228
Baker, Thomas
5131 Beacon Hill Rd
Columbus, OH 43228
Details
Gretzel King
Phone Number
(614) 878-6413
Office Locations
104 N Murray Hill Rd
Columbus, OH 43228
104 N Murray Hill Rd Columbus OH, 43228

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