Medicare Advantage Plan Benefit Details in Plain Text|
|The following Medicare Advantage plan benefits apply to the Evercare Plan DH (HMO SNP) plan (H5253 - 024) in Green Lake, Wisconsin only.
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Click here to see this information for the Evercare Plan DH (HMO SNP) plan in a chart format along with the plan enrollment options. We will also send a copy of the plan benefit details chart to your email account.|
|The Evercare Plan DH (HMO SNP) plan has a monthly premium of $27.70. That is $332.40 for 12 months. There are a few factors that can increase or decrease this premium.
If you qualify for full or partial extra help, your premium will be lower. If you have a premium penalty, your premium will be higher.
Please remember that the $27.70 montly premium is in addition to your Medicare Part B premium.|
|This Medicare Advantage Plan with Prescription Drug Coverage is a Local HMO plan. Since this plan is a Special Needs Plan (SNP), only people who meet the eligibility requirement are permitted to enroll in the plan. The eligiblity requirement for this plan is Dual-Eligible. The features of a SNP plan are made to better serve people who meet the eligiblity requirements.|
|Plan Membership and Plan Ratings|
|The Evercare Plan DH (HMO SNP) plan a new plan in Green Lake county, therefore we do not yet have membership figures.and The Centers for Medicare and Medicaid Services (CMS) has rated the plan carrier as follows: a Customer Service Rating of 4 out of 5 stars a Member Experience Rating of 4 out of 5 stars a Drug Cost Information Accuracy Rating of 4 out of 5 stars. |
|Prescription Drug Coverage: Deductible, Cost-sharing, Formulary|
|This plan has a $310.00 deductible. That means that you are 100% responsible for the first $310.00 in medication costs and after that is met, the Evercare Plan DH (HMO SNP) plan will share the costs of your medications with you. (See cost-sharing below). $310.00 is the maximum deductible for 2011. There are other plans with a lower deductible or even a $0 deductible.|
|The Initial Coverage Phase (ICP) can be thought of as the cost-sharing phase of the plan. During this phase, you and the insurance company share your prescription costs. Once you have spent $310.00, your initial coverage phase will start. All medication are divided into tiers within the plans formulary. This helps the plan to organize and manage the prescription cost-sharing. The Evercare Plan DH (HMO SNP) plan’s formulary is divided into tiers. Every plan can name their tiers differently, and can place medications on any tier. The cost-sharing for this plan has not yet been released by CMS. We expect to have the cost-sharing information mid-October.|
|The Coverage Gap, which is also known as the Donut (Doughnut) Hole is the phase of your Medicare Part D plan where
you are responsible for 100% of your medication costs. Healthcare Reform mandates that the insurance carrier pay 7% of your generic drug prescription costs in the donut hole on your behalf.
The brand-name drug pharmceutical company will pay 50% of the cost of your brand-name drugs pruchased in the donut hole on your behalf. Since the brand-name drug manufacturer pays on
your behalf, the portion that they pay counts toward your TrOOP (or True Out of Pocket) costs. Some Medicare Part D plans offer coverage during the Coverage Gap that is beyond the mandated discounts.
Any drug not covered by the plan’s Gap Coverage will still receive the discounts noted above -- even if the plan has "No Coverage". This plan (Evercare Plan DH (HMO SNP)) offers No Coverage during the Coverage Gap phase.|
|The Evercare Plan DH (HMO SNP) plan offers many Health and Prescription Drug Coverage Benefits. The following section will describe these benefits in detail.|