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This is archive material for research purposes. Please see PDPFinder.com or MAFinder.com for current plans.

2016 Cigna-HealthSpring TotalCare SMS (HMO SNP) in Pearl River, Mississippi

Medicare Advantage Plan Benefit Details in Plain Text
The following Medicare Advantage plan benefits apply to the Cigna-HealthSpring TotalCare SMS (HMO SNP) (H4407 - 004) in Pearl River, Mississippi .

This plan is administered by HEALTHSPRING OF TENNESSEE, INC..  To switch to a different Medicare Advantage plan or to change your location, click here.
Click here to see the Cigna-HealthSpring TotalCare SMS (HMO SNP) health and prescription benefit details in chart format or email and view benefits chart

Plan Premium
The Cigna-HealthSpring TotalCare SMS (HMO SNP) has a monthly premium of $28.10. That is $337.20 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 $28.10 montly premium is in addition to your Medicare Part B premium. If you have a premium penalty, your premium will be higher. Or if you have a higher income you would be subject to the Income Related Adjustment Amount (IRMAA).

This Medicare Advantage Plan with Prescription Drug Coverage is a Local HMO plan.

Plan Membership and Plan Ratings
The Cigna-HealthSpring TotalCare SMS (HMO SNP) (H4407 - 004) currently has 2,707 members. There are 169 members enrolled in this plan in Pearl River, Mississippi, and 2,664 members in Mississippi.

The Centers for Medicare and Medicaid Services (CMS) has given this plan carrier a summary rating of 4 stars. The detail CMS plan carrier ratings are as follows:
Prescription Drug Coverage: Deductible, Cost-sharing, Formulary
This plan has a $360 deductible. So, you are 100% responsible for the first $360 in medication costs. After you have met the deductible, the Cigna-HealthSpring TotalCare SMS (HMO SNP) will share the costs of your medications with you -- see cost-sharing below. $360 is the maximum deductible for 2016. There are other plans with a lower deductible or even a $0 deductible for all formulary drugs. Click here to review plans with a $0 deductible.

The following information is about the Cigna-HealthSpring TotalCare SMS (HMO SNP) formulary (or drug list). There are 3253 drugs on the Cigna-HealthSpring TotalCare SMS (HMO SNP) formulary. Click here to browse the Cigna-HealthSpring TotalCare SMS (HMO SNP) Formulary.
 
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 $360, 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 Cigna-HealthSpring TotalCare SMS (HMO SNP)’s formulary is divided into tiers. Every plan can name their tiers differently, and can place medications on any tier. The Tier Cost-sharing data is not yet available.

Click here to browse the Cigna-HealthSpring TotalCare SMS (HMO SNP) Formulary.

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 42% of your generic drug prescription costs in the donut hole on your behalf.

The brand-name drug manufacturer will pay 50% and your plan will pay an additional 5% of the cost of your brand-name drugs purchased in the Donut Hole, for a total of 55% discount. The 50% paid by the brand-name drug manufacturer is paid on your behalf and therefore counts toward your TrOOP (or True Out-of-Pocket) costs. The portion paid by your plan, does not count toward TrOOP. 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 Gap Coverage". This plan (Cigna-HealthSpring TotalCare SMS (HMO SNP)) offers No Coverage during the Coverage Gap phase.

The Cigna-HealthSpring TotalCare SMS (HMO SNP) offers many Health and Prescription Drug Coverage Benefits. The following section will describe these benefits in detail.

** Cost **
Monthly premium, deductible, and limits on how much you pay for covered services
$28.1 per month. In addition you must keep paying your Medicare Part B premium.
$0 to $74 per year for Part D prescription drugs.
Yes. Like all Medicare health plans our plan protects you by having yearly limits on your out-of-pocket costs for medical and hospital care.
In this plan you may pay nothing for Medicare-covered services depending on your level of [insert State Medicaid plan name] eligibility.
Your yearly limit(s) in this plan:
  • $6 700 for services you receive from in-network providers.
If you reach the limit on out-of-pocket costs you keep getting covered hospital and medical services and we will pay the full cost for the rest of the year.

Refer to the "Medicare & You" handbook for Medicare-covered services. For [insert State Medicaid plan name]-covered services refer to the Medicaid Coverage section in this document.

Please note that you will still need to pay your monthly premiums and cost-sharing for your Part D prescription drugs.
Our plan has a coverage limit every year for certain in-network benefits. Contact us for the services that apply.
** Doctor and Hospital Choice **
Acupuncture
Not covered
** Extra Benefits **
Inpatient mental health care
For inpatient mental health care see the "Mental Health Care" section.
Outpatient prescription drugs
For Part B drugs such as chemotherapy drugs1:  0% or 20% of the cost
Other Part B drugs1:  0% or 20% of the cost
Depending on your income and institutional status you pay the following:
For generic drugs (including brand drugs treated as generic) either:
  • $0 copay; or
  • $1.20 copay; or
  • $2.95 copay

    • For all other drugs either:
  • $0 copay; or
  • $3.60 copay; or
  • $7.40 copay.
    • You may get your drugs at network retail pharmacies and mail order pharmacies.
    If you reside in a long-term care facility you pay the same as at a retail pharmacy.
    You may get drugs from an out-of-network pharmacy at the same cost as an in-network pharmacy.
    After your yearly out-of-pocket drug costs (including drugs purchased through your retail pharmacy and through mail order) reach $4 850 you pay nothing for all drugs.
    ** Important Information **
    Monthly premium, deductible, and limits on how much you pay for covered services
    $28.1 per month. In addition you must keep paying your Medicare Part B premium.
    $0 to $74 per year for Part D prescription drugs.
    Yes. Like all Medicare health plans our plan protects you by having yearly limits on your out-of-pocket costs for medical and hospital care.
    In this plan you may pay nothing for Medicare-covered services depending on your level of [insert State Medicaid plan name] eligibility.
    Your yearly limit(s) in this plan:
    • $6 700 for services you receive from in-network providers.
    If you reach the limit on out-of-pocket costs you keep getting covered hospital and medical services and we will pay the full cost for the rest of the year.

    Refer to the "Medicare & You" handbook for Medicare-covered services. For [insert State Medicaid plan name]-covered services refer to the Medicaid Coverage section in this document.

    Please note that you will still need to pay your monthly premiums and cost-sharing for your Part D prescription drugs.
    Our plan has a coverage limit every year for certain in-network benefits. Contact us for the services that apply.
    ** Outpatient Care and Services **
    Acupuncture
    Not covered
    Ambulance
    $0 or $250 copay or 0% or 20% of the cost depending on the service
    Chiropractic care
    Manipulation of the spine to correct a subluxation (when 1 or more of the bones of your spine move out of position):  You pay nothing
    Dental services
    Limited dental services (this does not include services in connection with care treatment filling removal or replacement of teeth):  You pay nothing
    Preventive dental services:
  • Cleaning (for up to 1 every six months):  You pay nothing
  • Dental x-ray(s) (for up to 1):  You pay nothing
  • Oral exam (for up to 1 every six months):  You pay nothing
    • Diabetes supplies and services
    Diabetes monitoring supplies:  0-20% of the cost depending on the supply
    Diabetes self-management training:  You pay nothing
    Therapeutic shoes or inserts:  0% or 20% of the cost
    Diagnostic tests, lab and radiology services, and x-rays (Costs for these services may be different if received in an outpatient surgery setting)
    Diagnostic radiology services (such as MRIs CT scans):  0% or 20% of the cost
    Diagnostic tests and procedures:  0-20% of the cost depending on the service
    Lab services:  You pay nothing
    Outpatient x-rays:  0% or 20% of the cost
    Therapeutic radiology services (such as radiation treatment for cancer):  0% or 20% of the cost
    Doctor's office visits
    Primary care physician visit:  You pay nothing
    Specialist visit:  You pay nothing
    Durable medical equipment (wheelchairs, oxygen, etc.)
    0% or 20% of the cost
    Emergency care
    $0 or $75 copay
    If you are admitted to the hospital within 24 hours you do not have to pay your share of the cost for emergency care. See the "Inpatient Hospital Care" section for other costs.
    Foot care (podiatry services)
    Foot exams and treatment if you have diabetes-related nerve damage and/or meet certain conditions:  You pay nothing
    Hearing services
    Exam to diagnose and treat hearing and balance issues:  You pay nothing
    Routine hearing exam (for up to 1 every year):  You pay nothing
    Hearing aid fitting/evaluation (for up to 1 every three years):  You pay nothing
    Hearing aid:  You pay nothing
    Our plan pays up to $500 every three years for hearing aids.
    Home health care
    You pay nothing
    Mental health care
    Inpatient visit:
    Our plan covers up to 190 days in a lifetime for inpatient mental health care in a psychiatric hospital. The inpatient hospital care limit does not apply to inpatient mental services provided in a general hospital.
    Our plan covers 90 days for an inpatient hospital stay.
    Our plan also covers 60 "lifetime reserve days." These are "extra" days that we cover. If your hospital stay is longer than 90 days you can use these extra days. But once you have used up these extra 60 days your inpatient hospital coverage will be limited to 90 days.
    • $0 or $245 copay per day for days 1 through 6
    • You pay nothing per day for days 7 through 90
      • Outpatient group therapy visit:  You pay nothing
      Outpatient individual therapy visit:  You pay nothing
      Outpatient rehabilitation
      Cardiac (heart) rehab services (for a maximum of 2 one-hour sessions per day for up to 36 sessions up to 36 weeks):  $0 or $10 copay
      Occupational therapy visit:  You pay nothing
      Physical therapy and speech and language therapy visit:  You pay nothing
      Outpatient substance abuse
      Group therapy visit:  You pay nothing
      Individual therapy visit:  You pay nothing
      Outpatient surgery
      Ambulatory surgical center:  $0 or $195 copay
      Outpatient hospital:  $0 or $260 copay
      Over-the-counter items
      Not Covered
      Prosthetic devices (braces, artificial limbs, etc.)
      Prosthetic devices:  0% or 20% of the cost
      Related medical supplies:  0% or 20% of the cost
      Renal dialysis
      0% or 20% of the cost
      Transportation
      Not covered
      Urgently needed services
      You pay nothing
      Vision services
      Exam to diagnose and treat diseases and conditions of the eye (including yearly glaucoma screening):  You pay nothing
      Routine eye exam (for up to 1 every year):  You pay nothing
      Contact lenses:  You pay nothing
      Eyeglasses (frames and lenses) (for up to 1 every year):  You pay nothing
      Eyeglass frames (for up to 1 every year):  You pay nothing
      Eyeglass lenses (for up to 1 every year):  You pay nothing
      Eyeglasses or contact lenses after cataract surgery:  You pay nothing
      Our plan pays up to $100 every year for eyewear.
      ** Hospice **
      Hospice
      You pay nothing for hospice care from a Medicare-certified hospice. You may have to pay part of the cost for drugs and respite care.
      ** Preventive Care **
      Preventive care
      You pay nothing
      Our plan covers many preventive services including:
      • Abdominal aortic aneurysm screening
      • Alcohol misuse counseling
      • Bone mass measurement
      • Breast cancer screening (mammogram)
      • Cardiovascular disease (behavioral therapy)
      • Cardiovascular screenings
      • Cervical and vaginal cancer screening
      • Colorectal cancer screenings (Colonoscopy Fecal occult blood test Flexible sigmoidoscopy)
      • Depression screening
      • Diabetes screenings
      • HIV screening
      • Medical nutrition therapy services
      • Obesity screening and counseling
      • Prostate cancer screenings (PSA)
      • Sexually transmitted infections screening and counseling
      • Tobacco use cessation counseling (counseling for people with no sign of tobacco-related disease)
      • Vaccines including Flu shots Hepatitis B shots Pneumococcal shots
      • "Welcome to Medicare" preventive visit (one-time)
      • Yearly "Wellness" visit
      Any additional preventive services approved by Medicare during the contract year will be covered.
      Annual physical exam:  You pay nothing
      ** Inpatient Care **
      Inpatient hospital care
      Our plan covers 90 days for an inpatient hospital stay.
      Our plan also covers 60 "lifetime reserve days." These are "extra" days that we cover. If your hospital stay is longer than 90 days you can use these extra days. But once you have used up these extra 60 days your inpatient hospital coverage will be limited to 90 days.
      • $0 or $270 copay per day for days 1 through 7
      • You pay nothing per day for days 8 through 90
        • Inpatient mental health care
        For inpatient mental health care see the "Mental Health Care" section.
        Skilled Nursing Facility (SNF)
        Our plan covers up to 100 days in a SNF.
        • You pay nothing per day for days 1 through 20
        • $0 or $160 copay per day for days 21 through 100
          • Outpatient prescription drugs
          For Part B drugs such as chemotherapy drugs1:  0% or 20% of the cost
          Other Part B drugs1:  0% or 20% of the cost
          Depending on your income and institutional status you pay the following:
          For generic drugs (including brand drugs treated as generic) either:
        • $0 copay; or
        • $1.20 copay; or
        • $2.95 copay

          • For all other drugs either:
        • $0 copay; or
        • $3.60 copay; or
        • $7.40 copay.
          • You may get your drugs at network retail pharmacies and mail order pharmacies.
          If you reside in a long-term care facility you pay the same as at a retail pharmacy.
          You may get drugs from an out-of-network pharmacy at the same cost as an in-network pharmacy.
          After your yearly out-of-pocket drug costs (including drugs purchased through your retail pharmacy and through mail order) reach $4 850 you pay nothing for all drugs.
          ** Outpatient Care **
          Diabetes supplies and services
          Diabetes monitoring supplies:  0-20% of the cost depending on the supply
          Diabetes self-management training:  You pay nothing
          Therapeutic shoes or inserts:  0% or 20% of the cost
          Foot care (podiatry services)
          Foot exams and treatment if you have diabetes-related nerve damage and/or meet certain conditions:  You pay nothing
          Hearing services
          Exam to diagnose and treat hearing and balance issues:  You pay nothing
          Routine hearing exam (for up to 1 every year):  You pay nothing
          Hearing aid fitting/evaluation (for up to 1 every three years):  You pay nothing
          Hearing aid:  You pay nothing
          Our plan pays up to $500 every three years for hearing aids.
          ** Outpatient Medical Services and Supplies **
          Outpatient substance abuse
          Group therapy visit:  You pay nothing
          Individual therapy visit:  You pay nothing
          Prosthetic devices (braces, artificial limbs, etc.)
          Prosthetic devices:  0% or 20% of the cost
          Related medical supplies:  0% or 20% of the cost
          ** Additional Benefits **
          Inpatient mental health care
          For inpatient mental health care see the "Mental Health Care" section.




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          .