2019 SeniorCare Advantage Premium (HMO) H8142-6-0 in TX from Scott and White Health Plan | HealthPocket

SeniorCare Advantage Premium (HMO)

$199/mo

Apply For This Plan

Zip Code79936
Applicant1/19/1984 Male
Coverage Start1/20/2019
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Benefits & Coverage

Insurance TypeMedicare Advantage Plan (Part C)
Insurance ProviderScott and White Health Plan
Plan IDH8142-6-0
Plan Year2019
CMS Rating
Plan TypeHMO
Annual Deductible$0.00

What To Know About This Plan
  • This is a health coverage only plan with no drug coverage

Costs and Other Important Information

Plan Year2019
Monthly Health Plan Premium$199.00
Monthly Drug Plan PremiumNot Applicable
Health Plan Deductible$0
Other health plan deductibles?No
Maximum out-of-pocket enrollee responsibility (does not include prescription drugs)$3,400 In-network
Optional Supplemental BenefitsNo

Benefits

SERVICECOST
Inpatient hospital coverage$0 copay
Outpatient hospital coverage$0 copay
Doctor visitsPrimary:$0 copay
Specialist:$0 copay
Preventive care$0 copay
Emergency care/Urgent careEmergency:$120 per visit (always covered)
Urgent care:$40 per visit (always covered)
Diagnostic procedures/lab services/imagingDiagnostic tests and procedures:$0 copay
Lab services:$0 copay
Diagnostic radiology services (e.g., MRI):$0 copay
Outpatient x-rays:$0 copay
Mental health servicesInpatient hospital - psychiatric:$0 copay
Outpatient group therapy visit with a psychiatrist:$0 copay
Outpatient individual therapy visit with a psychiatrist:$0 copay
Outpatient group therapy visit:$0 copay
Outpatient individual therapy visit:$0 copay
Skilled Nursing Facility$0 per day for days 1 through 20
$15 per day for days 21 through 100
Rehabilitation servicesOccupational therapy visit:$0 copay
Physical therapy and speech and language therapy visit:$0 copay
Ground ambulance$40
TransportationNot covered
Foot care (podiatry services)Foot exams and treatment:$0 copay
Routine foot care:Not covered
Medical equipment/suppliesDurable medical equipment (e.g., wheelchairs, oxygen):$0 copay
Prosthetics (e.g., braces, artificial limbs):$0 copay
Diabetes supplies:$0 copay
Wellness programs (e.g., fitness, nursing hotline)Covered
Medicare Part B drugsChemotherapy:$0 copay
Other Part B drugs:$0 copay

Benefits Services

Hearing
Hearing exam$0 copay
Fitting/evaluation$0 copay
Hearing aids$0 copay. There may be limits on how much the plan will provide.
Preventive Dental
Oral exam$0 copay. There may be limits on how much the plan will provide.
Cleaning$0 copay. There may be limits on how much the plan will provide.
Fluoride treatmentNot covered
Dental x-ray(s)$0 copay. There may be limits on how much the plan will provide.
Comprehensive Dental
Non-routine servicesNot covered
Diagnostic services$0 copay. There may be limits on how much the plan will provide.
Restorative servicesNot covered
EndodonticsNot covered
PeriodonticsNot covered
Extractions50%There may be limits on how much the plan will provide.
Prosthodontics, other oral/maxillofacial surgery, other services50%There may be limits on how much the plan will provide.
Vision
Routine eye exam$0 copay. There may be limits on how much the plan will provide.
OtherNot covered
Contact lenses$0 copay. There may be limits on how much the plan will provide.
Eyeglasses (frames and lenses)$0 copay. There may be limits on how much the plan will provide.
Eyeglass frames$0 copay. There may be limits on how much the plan will provide.
Eyeglass lenses$0 copay. There may be limits on how much the plan will provide.
UpgradesNot covered

Coverage Area for SeniorCare Advantage Premium (HMO)

StateTexas
CountyEl Paso

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 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 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 careNot Rated
Getting appointments and care quicklyNot Rated
Customer serviceNot Rated
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-forwardNot Rated
Appeals upheldNot Rated

Member Complaints, and Changes in Drug Plan's Performance

Complaints about the drug plan
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

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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.

Medicare Plans Found

 

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.