2018 CMC Care Advantage Vida (HMO) (HMO) H0904-4-0 in PR from CMC Care Advantege | HealthPocket

CMC Care Advantage Vida (HMO) (HMO)

Medicare Advantage Plan for Puerto Rico

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PARTCRX

Plan Summary

Insurance TypeMedicare Advantage Plan (Part C w/ RX)
Insurance ProviderCMC Care Advantege
Plan IDH0904-4-0
CMS RatingNot Rated1
Plan TypeHMO
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)
$3,400.01 In-network
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
$0 copay
Outpatient hospital coverage
$0 copay
Doctor visits
Primary:
$0 copay
Specialist:
$6 per visit
Preventive care
$0 copay
Emergency care/Urgent care
Emergency:
$45 per visit (always covered)
Urgent care:
$0 copay
Diagnostic procedures/lab services/imaging
Diagnostic tests and procedures:
$0 copay
Lab services:
$0 copay
Diagnostic radiology services (e.g., MRI):
10%
Outpatient x-rays:
10%
Mental health services
$0 copay
Outpatient group therapy visit with a psychiatrist:
$6
Outpatient individual therapy visit with a psychiatrist:
$6
Outpatient group therapy visit:
$0 copay
Outpatient individual therapy visit:
$0 copay
Skilled Nursing Facility
$0 copay
Rehabilitation services
Occupational therapy visit:
$0 copay
Physical therapy and speech and language therapy visit:
$0 copay
Ambulance
$0 copay
Transportation
$0 copay
Foot care (podiatry services)
Foot exams and treatment:
$6
Routine foot care:
$6
Medical equipment/supplies
Durable medical equipment (e.g., wheelchairs, oxygen):
15% per item
Prosthetics (e.g., braces, artificial limbs):
15% per item
Diabetes supplies:
$0 copay
Wellness programs (e.g., fitness, nursing hotline)
Covered
Medicare Part B drugs
Chemotherapy:
10%
Other Part B drugs:
20%

Coverage Area for CMC Care Advantage Vida (HMO) (HMO)

StatePuerto Rico
CountySan Juan

Physician Finder

Physicians that accept CMC Care Advantage Vida (HMO) (HMO) for Puerto Rico

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