CHRISTUS Health Generations (HMO)

Medicare Advantage Plan for Texas

select spinner
PARTCRX

Plan Summary

Insurance TypeMedicare Advantage Plan (Part C w/ RX)
Insurance ProviderCHRISTUS Health Plan Generations
Plan IDH1189-3-0
CMS RatingNot Rated1
Plan TypeHMO
Annual Deductible$150.00

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 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
$320 for days 1 through 5
$0 for days 6 through 90
Outpatient hospital coverage
$325 per visit
Doctor visits
Primary:$20 per visit
Specialist:$45 per visit
Preventive care
$0 copay
Emergency care/Urgent care
Emergency:$75 per visit (always covered)
Urgent care:$35 per visit (always covered)
Diagnostic procedures/lab services/imaging
Diagnostic tests and procedures:$50
Lab services:$0 copay
Diagnostic radiology services (e.g., MRI):$150
Outpatient x-rays:$25
Mental health services
$318 for days 1 through 5
$0 for days 6 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
$0 for days 1 through 20
$164.50 for days 21 through 100
Rehabilitation services
Occupational therapy visit:$25
Physical therapy and speech and language therapy visit:$25
Ambulance
$265
Transportation
$0 copay
Foot care (podiatry services)
Foot exams and treatment:$45
Routine foot care:$0 copay
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 CHRISTUS Health Generations (HMO)

StateTexas
CountyEl Paso

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$4 copayNot offered
Tier 2: Non-Preferred GenericNot offered$10 copayNot offered
Tier 3: Preferred Brand NameNot offered$35 copayNot offered
Tier 4: Non-Preferred Brand NameNot offered$90 copayNot offered
Tier 5: Specialty TierNot offered29% coinsuranceNot offered
90 Day SupplyPreferred Retail PharmaciesNon-Preferred Retail PharmaciesMail-Order Pharmacies
Tier 1: Preferred GenericNot offered$12 copayNot offered
Tier 2: Non-Preferred GenericNot offered$30 copayNot offered
Tier 3: Preferred Brand NameNot offered$105 copayNot offered
Tier 4: Non-Preferred Brand NameNot offered$270 copayNot offered
Tier 5: Specialty TierNot offered29% coinsuranceNot offered

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
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
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
Part D medication adherence for hypertension
Not Rated
Part D medication adherence for cholesterol
Medication Therapy Management program completion rate

Physician Finder

Physicians that accept CHRISTUS Health Generations (HMO) for Texas

/

No results found. Try changing the search distance or zip code.

Similar Plans

PremiumPlan NameCMS Rating
from $0
KelseyCare Advantage Rx (HMO)
Details
from $0
AARP MedicareComplete Plan 1 (HMO)
Details
from $23
SilverScript Choice (PDP)
Details
from $0
Cigna-HealthSpring Preferred (HMO)
Details
from $0
TexanPlus Classic (HMO)
Details

Related Articles

Related Searches

HealthPocket is a free information source designed to help consumers find medical coverage. Whether you are looking for Medicare, Medicaid or an individual 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.

{}