2020 Vibra Health Plan Essential (PPO) H9408-001-000 in PA from Vibra Health Plan | HealthPocket

Vibra Health Plan Essential (PPO)

$0/mo

Benefits & Coverage

Insurance TypeMedicare Advantage Plan (Part C w/ RX)
Insurance ProviderVibra Health Plan
Plan IDH9408-001-000
Plan Year2020
CMS Rating
Plan TypePPO
Annual Deductible$0.00
Out-of-Pocket Maximum6700

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
  • has a copay of $0 for Tier 1 preferred generic drugs (30 day supply, preferred retail pharmacies)

Overview

Premium
Total monthly premium$0.00
Health plan premium$0.00
Drug plan premium$0.00
Standard Part B premium$135.50
Part B premium reductionNo
Deductible
Health plan deductible$0
Drug plan deductible$0.00
Estimated yearly costs
Estimated total yearly costs for care$3,978.00
Out-of-pocket max
Out-of-pocket max$10,000 In and Out-of-network
$6,700 In-network

Benefits & costs

Doctor services
Primary doctor visitIn-network: $5 per visit
Out-of-network: $5 per visit
Specialist visitIn-network: $40 per visit
Out-of-network: $40 per visit
Tests, labs, & imaging
Diagnostic tests & proceduresIn-network: $25
Out-of-network: $25
Lab servicesIn-network: $15
Out-of-network: $15
Diagnostic radiology services (like MRI)In-network: $275
Out-of-network: $275
Outpatient x-raysIn-network: $50
Out-of-network: $50
Emergency care$90 per visit (always covered)
Urgent care$65 per visit (always covered)
Hospital services
Inpatient hospital coverageIn-network: $210 per day for days 1 through 8
$0 per day for days 9 through 90
Out-of-network: $210 per day for days 1 through 8
$0 per day for days 9 through 90
Outpatient hospital coverageIn-network: $325 per visit
Out-of-network: $325 per visit
Skilled nursing facility
Skilled nursing facilityIn-network: $0 per day for days 1 through 5
$0 per day for days 6 through 20
$172 per day for days 21 through 100
Out-of-network: $0 per day for days 1 through 5
$0 per day for days 6 through 20
$172 per day for days 21 through 100
Preventive services
Preventive servicesIn-network: $0 copay
Out-of-network: 20%
Ambulance
Ground ambulanceIn-network: $225
Out-of-network: $225
Therapy services
Occupational therapy visitIn-network: $40
Out-of-network: $40
Physical therapy & speech & language therapy visitIn-network: $40
Out-of-network: $40
Mental health services
Outpatient group therapy with a psychiatristIn-network: $40
Out-of-network: $40
Outpatient individual therapy with a psychiatristIn-network: $40
Out-of-network: $40
Outpatient group therapy visitIn-network: $40
Out-of-network: $40
Outpatient individual therapy visitIn-network: $40
Out-of-network: $40
Opioid treatment services
Opioid treatment servicesCovered
Other services
Durable medical equipment (like wheelchairs & oxygen)In-network: 20% per item
Out-of-network: 20% per item
Prosthetics (like braces, artificial limbs)In-network: 20% per item
Out-of-network: 20% per item
Diabetes suppliesIn-network: $0 per item
Out-of-network: 20% per item

Extra benefits & costs

Hearing
Hearing examIn-network: $40
Out-of-network: $40
Fitting/evaluationIn-network: $0 copay
Out-of-network: 50%
Hearing aids - All typesIn-network: $0 copay
Out-of-network: $0 copay
Preventive dental
Oral examCovered under office visit
CleaningCovered under office visit
Fluoride treatmentNot covered
Dental x-raysCovered under office visit
Comprehensive dental
Non-routine servicesIn-network: 50%
Out-of-network: 50%
Diagnostic servicesNot covered
Restorative servicesIn-network: 50%
Out-of-network: 50%
EndodonticsIn-network: 50%
Out-of-network: 50%
PeriodonticsNot covered
ExtractionsIn-network: 50%
Out-of-network: 50%
Prosthodontics, other oral/maxillofacial surgery, other servicesIn-network: 50%
Out-of-network: 50%
Vision
Routine eye examIn-network: $20
Out-of-network: 50%
Contact lensesIn-network: $0 copay
Out-of-network: $0 copay
Eyeglasses (frames & lenses)Not covered
Eyeglass frames (only)In-network: $0 copay
Out-of-network: $0 copay
Eyeglass lenses (only)In-network: $0 copay
Out-of-network: $0 copay
UpgradesNot covered
More benefits
Fitness benefitLimited coverage
Over the counter drug benefitsLimited coverage
In-home support servicesNot covered
Home and bathroom safety devicesNot covered
Meals for short durationNot covered
Annual physical examsNot covered
TelehealthNot covered

Drug coverage & costs

Part B drugs
Chemotherapy drugsIn-network: 20%
Out-of-network: 20%
Other Part B drugsIn-network: 20%
Out-of-network: 20%

All cost-sharing assumes in-network healthcare providers.
Prescription Drug Copay/Coninsurance Details - Initial Coverage Limit


30 Day SupplyPreferred Retail Pharmacies Drug CostStandard Retail Pharmacies Drug CostPreferred Mail-Order Drug CostStandard Mail-Order Drug Cost
Tier 1: Preferred Generic$0 copay$15 copay$0 copay$15 copay
Tier 2: Generic$0 copay$20 copay$0 copay$20 copay
Tier 3: Preferred Brand$40 copay$47 copay$40 copay$47 copay
Tier 4: Non-Preferred Drug$93 copay$100 copay$93 copay$100 copay
Tier 5: Specialty Tier33% coinsurance33% coinsurance33% coinsurance33% coinsurance
Tier 6: Select Care Drugs$0 copay$7 copay$0 copay$7 copay

60 Day SupplyPreferred Retail Pharmacies Drug CostStandard Retail Pharmacies Drug CostPreferred Mail-Order Drug CostStandard Mail-Order Drug Cost
Tier 1: Preferred Generic$0 copay$30 copay$0 copay$30 copay
Tier 2: Generic$0 copay$40 copay$0 copay$40 copay
Tier 3: Preferred Brand$80 copay$94 copay$80 copay$94 copay
Tier 4: Non-Preferred Drug$186 copay$200 copay$186 copay$200 copay
Tier 5: Specialty Tier
Tier 6: Select Care Drugs$0 copay$14 copay$0 copay$14 copay
90 Day SupplyPreferred Retail Pharmacies Drug CostStandard Retail Pharmacies Drug CostPreferred Mail-Order Drug CostStandard Mail-Order Drug Cost
Tier 1: Preferred Generic$0 copay$45 copay$0 copay$45 copay
Tier 2: Generic$0 copay$60 copay$0 copay$60 copay
Tier 3: Preferred Brand$120 copay$141 copay$120 copay$141 copay
Tier 4: Non-Preferred Drug$279 copay$300 copay$279 copay$300 copay
Tier 5: Specialty Tier
Tier 6: Select Care Drugs$0 copay$21 copay$0 copay$21 copay

Staying healthy - screenings, tests and vaccines

Breast cancer screeningNot Rated
Colorectal cancer screening
Annual flu vaccine
Improving or maintaining physical healthNot Rated
Improving or maintaining mental healthNot Rated
Monitoring physical ability
Adult BMI assessment

Managing Chronic Conditions

Special needs plan care managementNot Rated
Care for older adults – medication reviewNot Rated
Care for older adults – functional status assessmentNot Rated
Care for older adults – Pain screeningNot Rated
Osteoporosis management in women who had a fractureNot Rated
Diabetes care – eye exam
Diabetes care – kidney disease monitoring
Diabetes care – blood sugar controlled
Controlling blood pressureNot Rated
Rheumatoid arthritis management
Reducing the risk of falling
Plan all-cause readmissions

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 decisionsNot Rated
Call center – foreign language interpreter and TTY/TDD availability - MedicalNot Rated

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 planNot Rated
Members choosing to leave the drug plan
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
Statin Use in Persons with DiabetesNot Rated

Physicians that accept Vibra Health Essential (PPO) for Pennsylvania

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Medicare Plans Found

 

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HealthPocket is a free information source designed to help consumers find medical coverage. Whether you are looking for Medicare, or an individual and family health insurance plan, we will help you find the right healthcare option and save on your out of pocket healthcare costs. We receive our data from government, non-profit and private sources, and you should confirm key provisions of your coverage with your selected health plan. If you select a plan presented on our site, you will be directed (via a click or a call) to one of our partners who can help you with your application. Our website is not a health insurance agency and not affiliated with and does not represent or endorse any health plan. HealthPocket, Inc. is part of the Benefytt Technologies, Inc. family of companies.