.
.
.
. . .
. . .
Q1 Medicare.com Click to Enter Your Drugs and Compare Medicare Part D Plans
Powered by Q1Group LLC Powered by Q1Group LLC.
Education and Decision Support Tools for the Medicare Community
.
.
. . .
. . .
. . .
.
. Home Contact Us Enroll . .
. . MAPD PDP 2015 FAQ Blog
.
. . .
. . . . . . .
.

2015 Medicare Advantage Plan Benefits in Plain Text

Description of the Cigna-HealthSpring TotalCare (HMO SNP) plan (H3949 - 009) in Bucks, Pennsylvania



Medicare Advantage Plan Benefit Details in Plain Text
The following Medicare Advantage plan benefits apply to the Cigna-HealthSpring TotalCare (HMO SNP) plan (H3949 - 009) in Bucks, Pennsylvania only.   To switch to a different Medicare Advantage plan or to change your location, click here.
Click here to see this information for the Cigna-HealthSpring TotalCare (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.

Plan Premium
The Cigna-HealthSpring TotalCare (HMO SNP) plan has a monthly premium of $25.40. That is $304.80 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 $25.40 montly premium is in addition to your Medicare Part B premium.

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

Plan Membership and Plan Ratings
The Cigna-HealthSpring TotalCare (HMO SNP) plan currently has 26,188 members in Bucks county. The Centers for Medicare and Medicaid Services (CMS) has has given this plan carrier a summary rating of 3.50 stars. The detail CMS plan carrier ratings are as follows: , a Member Experience Rating of -1 out of 5 stars, and a Drug Cost Information Accuracy Rating of -1 out of 5 stars.

Prescription Drug Coverage: Deductible, Cost-sharing, Formulary
This plan has a $320.00 deductible. That means that you are 100% responsible for the first $320.00 in medication costs and after that is met, the Cigna-HealthSpring TotalCare (HMO SNP) plan will share the costs of your medications with you. (See cost-sharing below). $320.00 is the maximum deductible for 2015. There are other plans with a lower deductible or even a $0 deductible.
The following information is about the Cigna-HealthSpring TotalCare (HMO SNP) formulary (or drug list). There are 3087 drugs on the Cigna-HealthSpring TotalCare (HMO SNP) formulary. Click here to browse the Cigna-HealthSpring TotalCare (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 $320.00, 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 Cigna-HealthSpring TotalCare (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 is divided as follows:       

Click here to browse the Cigna-HealthSpring TotalCare (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 35% 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 (HMO SNP)) offers No Coverage during the Coverage Gap phase.
The Cigna-HealthSpring TotalCare (HMO SNP) plan 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
$25.4 per month. In addition you must keep paying your Medicare Part B premium.
This plan has deductibles for some hospital and medical services.
$0 or $147 per year for in-network services depending on your level of Medicaid eligibility.
This plan does not have a deductible 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.
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.
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.
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 and Other Alternative Therapies
Not covered
Extra Benefits - Inpatient Mental Health Care
For inpatient mental health care see the "Mental Health Care" section.
Extra Benefits - 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
Our plan does not have a deductible for Part D prescription drugs.
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
  • $2.65 copay

  • For all other drugs either:
  • $0 copay; or
  • $3.60 copay; or
  • $6.60 copay
  • You may get your drugs at network retail 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 $4 700 you pay nothing for all drugs.
    Important Information - Monthly Premium, Deductible, and Limits on How Much You Pay for Covered Services
    $25.4 per month. In addition you must keep paying your Medicare Part B premium.
    This plan has deductibles for some hospital and medical services.
    $0 or $147 per year for in-network services depending on your level of Medicaid eligibility.
    This plan does not have a deductible 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.
    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.
    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.
    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 and Other Alternative Therapies
    Not covered
    Outpatient Care and Services - Ambulance Services
    0% or 20% of the cost
    Outpatient Care and Services - Chiropractic Care
    Manipulation of the spine to correct a subluxation (when 1 or more of the bones of your spine move out of position):  0% or 20% of the cost
    Outpatient Care and Services - Dental Services
    Limited dental services (this does not include services in connection with care treatment filling removal or replacement of teeth):  0% or 20% of the cost
    Preventive dental services:
  • Cleaning (for up to 1 every six months):  You pay nothing
  • Dental x-ray(s) (for up to 1 every year):  You pay nothing
  • Oral exam (for up to 1 every six months):  You pay nothing
  • Outpatient Care and Services - Diabetes Supplies and Services
    Diabetes monitoring supplies:  0% or 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
    Outpatient Care and Services - Diagnostic Tests, Lab and Radiology Services, and X-Rays
    Diagnostic radiology services (such as MRIs CT scans):  0% or 20% of the cost
    Diagnostic tests and procedures:  0% or 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
    Outpatient Care and Services - Doctor&rsuo;s Office Visits
    Primary care physician visit:  0% or 10% of the cost
    Specialist visit:  $0 or $50 copay
    Outpatient Care and Services - Durable Medical Equipment (wheelchairs, oxygen, etc.)
    0% or 20% of the cost
    Outpatient Care and Services - Emergency Care
    $0 or $65 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.
    Outpatient Care and Services - Foot Care (podiatry services)
    Foot exams and treatment if you have diabetes-related nerve damage and/or meet certain conditions:  $0 or $50 copay
    Outpatient Care and Services - Hearing Services
    Exam to diagnose and treat hearing and balance issues:  0% or 20% of the cost
    Outpatient Care and Services - Home Health Care
    You pay nothing
    Outpatient Care and Services - 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 $210 copay per day for days 1 through 7
    • You pay nothing per day for days 8 through 90
    • Outpatient group therapy visit:  0% or 20% of the cost
      Outpatient individual therapy visit:  0% or 20% of the cost
      Outpatient Care and Services - Outpatient Rehabilitation Services
      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 20% of the cost
      Occupational therapy visit:  0% or 20% of the cost
      Physical therapy and speech and language therapy visit:  0% or 20% of the cost
      Outpatient Care and Services - Outpatient Substance Abuse
      Group therapy visit:  0% or 20% of the cost
      Individual therapy visit:  0% or 20% of the cost
      Outpatient Care and Services - Outpatient Surgery
      Ambulatory surgical center:  0% or 20% of the cost
      Outpatient hospital:  0% or 20% of the cost
      Outpatient Care and Services - Over-the-Counter Items
      Not Covered
      Outpatient Care and Services - Prosthetic Devices (braces, artificial limbs, etc.)
      Prosthetic devices:  0% or 20% of the cost
      Related medical supplies:  0% or 20% of the cost
      Outpatient Care and Services - Renal Dialysis
      0% or 20% of the cost
      Outpatient Care and Services - Transportation
        You pay nothing
      Outpatient Care and Services - Urgently Needed Care
      0% or 20% of the cost
      If you are admitted to the hospital within 24 hours you do not have to pay your share of the cost for urgent care. See the "Inpatient Hospital Care" section for other costs.
      Outpatient Care and Services - Vision Services
      Exam to diagnose and treat diseases and conditions of the eye (including yearly glaucoma screening):  0% or 0-20% of the cost depending on the service
      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 two years):  You pay nothing
      Eyeglasses or contact lenses after cataract surgery:  You pay nothing
      Our plan pays up to $100 every two years for contact lenses and eyeglasses (frames and lenses).
      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
      • Colonoscopy
      • Colorectal cancer screenings
      • Depression screening
      • Diabetes screenings
      • Fecal occult blood test
      • Flexible sigmoidoscopy
      • 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 Care - Inpatient Mental Health Care
        For inpatient mental health care see the "Mental Health Care" section.
        Inpatient Care - 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 $156 copay per day for days 21 through 100
        • Inpatient Care - 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
          Our plan does not have a deductible for Part D prescription drugs.
          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
        • $2.65 copay

        • For all other drugs either:
        • $0 copay; or
        • $3.60 copay; or
        • $6.60 copay
        • You may get your drugs at network retail 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 $4 700 you pay nothing for all drugs.
          Outpatient Care - Diabetes Supplies and Services
          Diabetes monitoring supplies:  0% or 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
          Outpatient Care - Foot Care (podiatry services)
          Foot exams and treatment if you have diabetes-related nerve damage and/or meet certain conditions:  $0 or $50 copay
          Outpatient Care - Hearing Services
          Exam to diagnose and treat hearing and balance issues:  0% or 20% of the cost
          Outpatient Medical Services and Supplies - Outpatient Substance Abuse
          Group therapy visit:  0% or 20% of the cost
          Individual therapy visit:  0% or 20% of the cost
          Outpatient Medical Services and Supplies - 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.

          Description of the Cigna-HealthSpring TotalCare (HMO SNP) plan (H3949 - 009) in Bucks, Pennsylvania



          Medicare Advantage Plan Benefit Details in Plain Text
          The following Medicare Advantage plan benefits apply to the Cigna-HealthSpring TotalCare (HMO SNP) plan (H3949 - 009) in Bucks, Pennsylvania only.   To switch to a different Medicare Advantage plan or to change your location, click here.
          Click here to see this information for the Cigna-HealthSpring TotalCare (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.

          Plan Premium
          The Cigna-HealthSpring TotalCare (HMO SNP) plan has a monthly premium of $25.40. That is $304.80 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 $25.40 montly premium is in addition to your Medicare Part B premium.

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

          Plan Membership and Plan Ratings
          The Cigna-HealthSpring TotalCare (HMO SNP) plan currently has 26,188 members in Bucks county. The Centers for Medicare and Medicaid Services (CMS) has has given this plan carrier a summary rating of 3.50 stars. The detail CMS plan carrier ratings are as follows: , a Member Experience Rating of -1 out of 5 stars, and a Drug Cost Information Accuracy Rating of -1 out of 5 stars.

          Prescription Drug Coverage: Deductible, Cost-sharing, Formulary
          This plan has a $320.00 deductible. That means that you are 100% responsible for the first $320.00 in medication costs and after that is met, the Cigna-HealthSpring TotalCare (HMO SNP) plan will share the costs of your medications with you. (See cost-sharing below). $320.00 is the maximum deductible for 2015. There are other plans with a lower deductible or even a $0 deductible.
          The following information is about the Cigna-HealthSpring TotalCare (HMO SNP) formulary (or drug list). There are 3087 drugs on the Cigna-HealthSpring TotalCare (HMO SNP) formulary. Click here to browse the Cigna-HealthSpring TotalCare (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 $320.00, 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 Cigna-HealthSpring TotalCare (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 is divided as follows:       

          Click here to browse the Cigna-HealthSpring TotalCare (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 35% 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 (HMO SNP)) offers No Coverage during the Coverage Gap phase.
          The Cigna-HealthSpring TotalCare (HMO SNP) plan 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
          $25.4 per month. In addition you must keep paying your Medicare Part B premium.
          This plan has deductibles for some hospital and medical services.
          $0 or $147 per year for in-network services depending on your level of Medicaid eligibility.
          This plan does not have a deductible 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.
          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.
          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.
          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 and Other Alternative Therapies
          Not covered
          Extra Benefits - Inpatient Mental Health Care
          For inpatient mental health care see the "Mental Health Care" section.
          Extra Benefits - 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
          Our plan does not have a deductible for Part D prescription drugs.
          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
        • $2.65 copay

        • For all other drugs either:
        • $0 copay; or
        • $3.60 copay; or
        • $6.60 copay
        • You may get your drugs at network retail 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 $4 700 you pay nothing for all drugs.
          Important Information - Monthly Premium, Deductible, and Limits on How Much You Pay for Covered Services
          $25.4 per month. In addition you must keep paying your Medicare Part B premium.
          This plan has deductibles for some hospital and medical services.
          $0 or $147 per year for in-network services depending on your level of Medicaid eligibility.
          This plan does not have a deductible 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.
          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.
          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.
          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 and Other Alternative Therapies
          Not covered
          Outpatient Care and Services - Ambulance Services
          0% or 20% of the cost
          Outpatient Care and Services - Chiropractic Care
          Manipulation of the spine to correct a subluxation (when 1 or more of the bones of your spine move out of position):  0% or 20% of the cost
          Outpatient Care and Services - Dental Services
          Limited dental services (this does not include services in connection with care treatment filling removal or replacement of teeth):  0% or 20% of the cost
          Preventive dental services:
        • Cleaning (for up to 1 every six months):  You pay nothing
        • Dental x-ray(s) (for up to 1 every year):  You pay nothing
        • Oral exam (for up to 1 every six months):  You pay nothing
        • Outpatient Care and Services - Diabetes Supplies and Services
          Diabetes monitoring supplies:  0% or 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
          Outpatient Care and Services - Diagnostic Tests, Lab and Radiology Services, and X-Rays
          Diagnostic radiology services (such as MRIs CT scans):  0% or 20% of the cost
          Diagnostic tests and procedures:  0% or 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
          Outpatient Care and Services - Doctor&rsuo;s Office Visits
          Primary care physician visit:  0% or 10% of the cost
          Specialist visit:  $0 or $50 copay
          Outpatient Care and Services - Durable Medical Equipment (wheelchairs, oxygen, etc.)
          0% or 20% of the cost
          Outpatient Care and Services - Emergency Care
          $0 or $65 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.
          Outpatient Care and Services - Foot Care (podiatry services)
          Foot exams and treatment if you have diabetes-related nerve damage and/or meet certain conditions:  $0 or $50 copay
          Outpatient Care and Services - Hearing Services
          Exam to diagnose and treat hearing and balance issues:  0% or 20% of the cost
          Outpatient Care and Services - Home Health Care
          You pay nothing
          Outpatient Care and Services - 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 $210 copay per day for days 1 through 7
          • You pay nothing per day for days 8 through 90
          • Outpatient group therapy visit:  0% or 20% of the cost
            Outpatient individual therapy visit:  0% or 20% of the cost
            Outpatient Care and Services - Outpatient Rehabilitation Services
            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 20% of the cost
            Occupational therapy visit:  0% or 20% of the cost
            Physical therapy and speech and language therapy visit:  0% or 20% of the cost
            Outpatient Care and Services - Outpatient Substance Abuse
            Group therapy visit:  0% or 20% of the cost
            Individual therapy visit:  0% or 20% of the cost
            Outpatient Care and Services - Outpatient Surgery
            Ambulatory surgical center:  0% or 20% of the cost
            Outpatient hospital:  0% or 20% of the cost
            Outpatient Care and Services - Over-the-Counter Items
            Not Covered
            Outpatient Care and Services - Prosthetic Devices (braces, artificial limbs, etc.)
            Prosthetic devices:  0% or 20% of the cost
            Related medical supplies:  0% or 20% of the cost
            Outpatient Care and Services - Renal Dialysis
            0% or 20% of the cost
            Outpatient Care and Services - Transportation
              You pay nothing
            Outpatient Care and Services - Urgently Needed Care
            0% or 20% of the cost
            If you are admitted to the hospital within 24 hours you do not have to pay your share of the cost for urgent care. See the "Inpatient Hospital Care" section for other costs.
            Outpatient Care and Services - Vision Services
            Exam to diagnose and treat diseases and conditions of the eye (including yearly glaucoma screening):  0% or 0-20% of the cost depending on the service
            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 two years):  You pay nothing
            Eyeglasses or contact lenses after cataract surgery:  You pay nothing
            Our plan pays up to $100 every two years for contact lenses and eyeglasses (frames and lenses).
            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
            • Colonoscopy
            • Colorectal cancer screenings
            • Depression screening
            • Diabetes screenings
            • Fecal occult blood test
            • Flexible sigmoidoscopy
            • 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 Care - Inpatient Mental Health Care
              For inpatient mental health care see the "Mental Health Care" section.
              Inpatient Care - 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 $156 copay per day for days 21 through 100
              • Inpatient Care - 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
                Our plan does not have a deductible for Part D prescription drugs.
                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
              • $2.65 copay

              • For all other drugs either:
              • $0 copay; or
              • $3.60 copay; or
              • $6.60 copay
              • You may get your drugs at network retail 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 $4 700 you pay nothing for all drugs.
                Outpatient Care - Diabetes Supplies and Services
                Diabetes monitoring supplies:  0% or 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
                Outpatient Care - Foot Care (podiatry services)
                Foot exams and treatment if you have diabetes-related nerve damage and/or meet certain conditions:  $0 or $50 copay
                Outpatient Care - Hearing Services
                Exam to diagnose and treat hearing and balance issues:  0% or 20% of the cost
                Outpatient Medical Services and Supplies - Outpatient Substance Abuse
                Group therapy visit:  0% or 20% of the cost
                Individual therapy visit:  0% or 20% of the cost
                Outpatient Medical Services and Supplies - 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.
                Click the +1 button if you have found this page useful:  



                .
                .
                Find a
                2014
                Medicare Supplement
                Enter Your ZIP Code:
                age:
                Gender: Male Female
                Smoker: Yes No
                Start Date for Coverage:
                .
                .


                .
                .

                Medicare Supplements
                fill the gaps in your
                Original Medicare
                1. Select Your State:


                Quick Links
                : : 2015 Part D PDP-Finder (Drug Only) Plan Finder
                : : Compare 2014/2015 PDP plans
                : : 2015 MA-Finder: Medicare Advantage Plan Finder
                : : Compare 2014/2015 Medicare Advantage plans
                : : 2015 Part D Drug Finder
                : : Browse Any 2015 Plan Formulary
                : : 2015 Browse Drugs By Letter
                : : Find a 2015 Plan by Drug Costs
                : : 2015 Part D plan Facts & Figures
                : : Medicare Part D Reminder Service: 2015
                .

                .
                Medicare PartD MAPD and PDP plan comparisons .

                .
                .
                : : 2015 Medicare Part D Rx plans
                : : PDP plan changes 2014 to 2015
                : : 2015 Medicare Advantage plans
                : : MA plan changes 2014 to 2015
                : : Browse any 2015 Drug Formulary
                : : Find a 2015 Medicare drug plan by drug cost
                : : Compare Medicare Rx and Health plans by drug costs
                : : Newsletter Sign-up
                . . . .


                .

                :: Click here to link to this page on your website
                .

                    Follow Q1Medicare on Twitter
                .

                   
                . .
                . . .
                . . .
                .
                .
                What’s New Most Viewed Press . .
                .
                . . .
                .
                Sitemap About Us Privacy Policy Newsletter Sign-up Blog FAQ Contact Us Terms Of Use Newsroom
                . Enroll in Medicare Part D © Q1Group LLC 2005 - 2014 . .
                . . .
                . . .
                .
                .
                . .

                .
                .
                .