Amerivantage Plus (HMO)

Medicare Advantage Plan for Tennessee

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PARTCRX

Plan Summary

Insurance TypeMedicare Advantage Plan (Part C w/ RX)
Insurance ProviderAmerigroup
Plan IDH7200-14-0
CMS Rating1
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)
$5,100 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
$295 for days 1 through 5
$0 for days 6 through 90
Outpatient hospital coverage
$0-275 per visit
Doctor visits
Primary:
$0 copay
Specialist:
$0-40 per visit
Preventive care
$0 copay
Emergency care/Urgent care
Emergency:
$80 per visit (always covered)
Urgent care:
$35 per visit (always covered)
Diagnostic procedures/lab services/imaging
Diagnostic tests and procedures:
$0-150
Lab services:
$0-10
Diagnostic radiology services (e.g., MRI):
$130-150
Outpatient x-rays:
$90-110
Mental health services
$250 for days 1 through 5
$0 for days 6 through 90
Outpatient group therapy visit with a psychiatrist:
$0-40
Outpatient individual therapy visit with a psychiatrist:
$0-40
Outpatient group therapy visit:
$0-40
Outpatient individual therapy visit:
$0-40
Skilled Nursing Facility
Tier 1
$0 for days 1 through 20
$137.50 for days 21 through 100
Tier 2
$0 for days 1 through 20
$167.50 for days 21 through 100
Rehabilitation services
Occupational therapy visit:
$40
Physical therapy and speech and language therapy visit:
$40
Ambulance
$295 or 20%
Transportation
$0 copay
Foot care (podiatry services)
Foot exams and treatment:
$0-50
Routine foot care:
$0 copay
Medical equipment/supplies
Durable medical equipment (e.g., wheelchairs, oxygen):
$0 or 20% per item
Prosthetics (e.g., braces, artificial limbs):
$0 or 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 Amerivantage Plus (HMO)

StateTennessee
CountyDavidson

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 Generic$2 copay$7 copayNot offered
Tier 2: Non-Preferred Generic$10 copay$15 copayNot offered
Tier 3: Preferred Brand Name$42 copay$47 copayNot offered
Tier 4: Non-Preferred Brand Name$95 copay$100 copayNot offered
Tier 5: Specialty Tier33% coinsurance33% coinsuranceNot offered
90 Day SupplyPreferred Retail PharmaciesNon-Preferred Retail PharmaciesMail-Order Pharmacies
Tier 1: Preferred Generic$6 copay$21 copayNot offered
Tier 2: Non-Preferred Generic$30 copay$45 copayNot offered
Tier 3: Preferred Brand Name$126 copay$141 copayNot offered
Tier 4: Non-Preferred Brand Name$285 copay$300 copayNot offered
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
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

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 Amerivantage Plus (HMO) for Tennessee

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DEVESH, VARALAKSHMI
2213 ALTERAS DR
ANTIOCH, TN 37013
HILL, BRADLEY
5801 CROSSINGS BLVD
ANTIOCH, TN 37013
MILLER, TIMOTHY
5801 CROSSINGS BLVD
ANTIOCH, TN 37013
LEONE, WILLIAM
5801 CROSSINGS BLVD
ANTIOCH, TN 37013
VO, THAO
700 CANOE RIDGE PT
ANTIOCH, TN 37013
D'AMICO, STEPHEN
4200 MURFREESBORO PIKE
ANTIOCH, TN 37013
NGUYEN, TRUNG
1001 CAPITAL FUNDS CT
NASHVILLE, TN 37217
NELSON, CLARISSA
2275 MURFREESBORO PIKE
NASHVILLE, TN 37217
BEECHER, LINDA
2275 MURFREESBORO PIKE STE 110
NASHVILLE, TN 37217
LAVIE, THOMAS
1921 RANSOM PL
NASHVILLE, TN 37217
Details
VARALAKSHMI DEVESH, M.D.
Phone Number
(404) 384-5444
Office Locations
2213 ALTERAS DR
ANTIOCH, TN 37013
2213 ALTERAS DR ANTIOCH TN, 37013

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