2019 Medical Associates SmartPlan (Cost) H5256-1-0 in WI from Medical Associates | HealthPocket

Medical Associates SmartPlan (Cost)

$115/mo

Apply For This Plan

Zip Code53215
Applicant12/14/1983 Male
Coverage Start12/15/2018
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Benefits & Coverage

Insurance TypeMedicare Advantage Plan (Part C)
Insurance ProviderMedical Associates
Plan IDH5256-1-0
Plan Year2019
CMS RatingNot Rated
Plan TypeCost
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$115.00
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)Not Applicable
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:$0 copay
Urgent care:$0 copay
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 copay
Rehabilitation servicesOccupational therapy visit:$0 copay
Physical therapy and speech and language therapy visit:$0 copay
Ground ambulance$0 copay
TransportationNot covered
Foot care (podiatry services)Foot exams and treatment:$0 copay
Routine foot care:$0 copay. There may be limits on how much the plan will provide.
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)Not covered
Medicare Part B drugsChemotherapy:Not Applicable
Other Part B drugs:Not Applicable

Benefits Services

Hearing
Hearing exam$0 copay
Fitting/evaluationNot covered
Hearing aids - inner earNot covered
Hearing aids - outer earNot covered
Hearing aids - over the earNot covered
Preventive Dental
Oral examNot covered
CleaningNot covered
Fluoride treatmentNot covered
Dental x-ray(s)Not covered
Comprehensive Dental
Non-routine servicesNot covered
Diagnostic servicesNot covered
Restorative servicesNot covered
EndodonticsNot covered
PeriodonticsNot covered
ExtractionsNot covered
Prosthodontics, other oral/maxillofacial surgery, other servicesNot covered
Vision
Routine eye exam$0 copay. There may be limits on how much the plan will provide.
OtherNot covered
Contact lensesNot covered
Eyeglasses (frames and lenses)Not covered
Eyeglass framesNot covered
Eyeglass lensesNot covered
UpgradesNot covered

Coverage Area for Medical Associates Smart (Cost)

StateWisconsin
CountyMilwaukee

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 fractureNot Rated
Diabetes care – eye exam
Diabetes care – kidney disease monitoring
Diabetes care – blood sugar controlled
Controlling blood pressure
Rheumatoid arthritis managementNot Rated
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 - MedicalNot Rated

Drug Plan Customer Service

Call center – foreign language interpreter and TTY/TDD availability - DrugsNot Rated
Appeals auto-forwardNot Rated
Appeals upheldNot Rated

Member Complaints, and Changes in Drug Plan's Performance

Complaints about the drug planNot Rated
Members choosing to leave the drug planNot Rated
Beneficiary access and performance problemsNot Rated
Drug plan quality improvementNot Rated

Member Experience with Drug Plan

Rating of drug planNot Rated
Getting needed prescription drugsNot Rated

Drug Pricing and Patient Safety

MPF Price AccuracyNot Rated
High risk medicationNot Rated
Part D medication adherence for diabetesNot Rated
Part D medication adherence for hypertensionNot Rated
Part D medication adherence for cholesterolNot Rated
Medication Therapy Management program completion rate Not Rated

Physicians that accept Medical Associates Smart (Cost) for Wisconsin

HumanaChoice H5216-178 (PPO)
COST:from $0CMS Rating:
Select
AARP MedicareComplete Essential (HMO)
COST:from $0CMS Rating:
Select
Anthem MediBlue Access Core (PPO)
COST:from $0CMS Rating:
Select
NetworkPrime (MSA)
COST:from $0CMS Rating:Not Rated
Select
Secure Saver (MSA)
COST:from $0CMS Rating:Not Rated
Select

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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.