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2015 Medicare Advantage Plan Benefit Details


Medicare Advantage Plan Benefit Details for:
AARP MedicareComplete Plus (HMO-POS)

2015 Medicare Advantage Plan Details
Plan Name:AARP MedicareComplete Plus (HMO-POS)
Location (County, State ZIP):Graham, Arizona
Plan ID:H0316 - 002     Click to see other plans

Click here for the AARP MedicareComplete Plus (HMO-POS) enrollment options and to have a copy of this chart sent to your email. Enroll in AARP MedicareComplete Plus (HMO-POS)

— Plan Features —
Monthly Premium:$39.00
Monthly Premium with Low-Income Subsidy:100%75%50%25%
$0.00$0.00$0.00$0.00
Annual Rx Deductible:$225
Health Plan Type:Local HMO
Maximum Out-of-Pocket Limit
for Parts A & B (MOOP):
$6,700
Gap Coverage:No Gap Coverage
Total Number of Formulary Drugs:3649    Browse Plan Formulary
Formulary Drug Details:Tier 1Tier 2Tier 3Tier 4Tier 5
  — Cost-Sharing during
       initial coverage phase:
$2.00$8.00$45.00$95.0033%
  — Number of Drugs per Tier:3105699601130680
Number of Members enrolled in this plan in your County:18,511 members
Plan’s Summary Star Rating: 3.00 out of 5 Stars.
   - Customer Service Rating: Insufficient data to rate this plan.
   - Member Experience Rating: 3 out of 5 Stars.
   - Drug Cost Accuracy Rating: 3 out of 5 Stars.

— Plan Health Benefits —
** Cost **
Monthly Premium, Deductible, and Limits on How Much You Pay for Covered Services
$39 per month. In addition you must keep paying your Medicare Part B premium.
$225 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.
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.
No. There are no limits on how much our plan will pay.
** 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.
Outpatient Prescription Drugs
For Part B drugs such as chemotherapy drugs:
  • In-network:  20% of the cost
  • Out-of-network:  40% of the cost
Other Part B drugs:
  • In-network:  20% of the cost
  • Out-of-network:  40% of the cost
After you pay your yearly deductible you pay the following until your total yearly drug costs reach $2 960. Total yearly drug costs are the total drug costs paid by both you and our Part D plan.
You may get your drugs at network retail pharmacies and mail order pharmacies.
Standard Retail Cost-Sharing
TierOne-month supplyThree-month supply
Tier 1 (Preferred Generic)$2 copay$6 copay
Tier 2 (Non-Preferred Generic)$8 copay$24 copay
Tier 3 (Preferred Brand)$45 copay$135 copay
Tier 4 (Non-Preferred Brand)$95 copay$285 copay
Tier 5 (Specialty Tier)33% of the cost33% of the cost
Preferred Mail Order Cost-Sharing
TierThree-month supply
Tier 1 (Preferred Generic)$4 copay
Tier 2 (Non-Preferred Generic)$16 copay
Tier 3 (Preferred Brand)$125 copay
Tier 4 (Non-Preferred Brand)$275 copay
Tier 5 (Specialty Tier)33% of the cost
Standard Mail Order Cost-Sharing
TierThree-month supply
Tier 1 (Preferred Generic)$6 copay
Tier 2 (Non-Preferred Generic)$24 copay
Tier 3 (Preferred Brand)$135 copay
Tier 4 (Non-Preferred Brand)$285 copay
Tier 5 (Specialty Tier)33% of the cost
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 but may pay more than you pay at an in-network pharmacy.
Most Medicare drug plans have a coverage gap (also called the "donut hole"). This means that there's a temporary change in what you will pay for your drugs. The coverage gap begins after the total yearly drug cost (including what our plan has paid and what you have paid) reaches $2 960.

After you enter the coverage gap you pay 45% of the plan's cost for covered brand name drugs and 65% of the plan's cost for covered generic drugs until your costs total $4 700 which is the end of the coverage gap. Not everyone will enter the coverage gap.

After your yearly out-of-pocket drug costs (including drugs purchased through your retail pharmacy and through mail order) reach $4 700 you pay the greater of:
  • 5% of the cost or
  • $2.65 copay for generic (including brand drugs treated as generic) and a $6.60 copayment for all other drugs.
** Important Information **
Monthly Premium, Deductible, and Limits on How Much You Pay for Covered Services
$39 per month. In addition you must keep paying your Medicare Part B premium.
$225 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.
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.
No. There are no limits on how much our plan will pay.
** Outpatient Care and Services **
Acupuncture and Other Alternative Therapies
Not covered
Ambulance Services
  • In-network:  $250 copay
  • Out-of-network:  $250 copay
Chiropractic Care
Manipulation of the spine to correct a subluxation (when 1 or more of the bones of your spine move out of position):
  • In-network:  $20 copay
  • Out-of-network:  $70 copay
Dental Services
Limited dental services (this does not include services in connection with care treatment filling removal or replacement of teeth):
  • In-network:  $50 copay
Diabetes Supplies and Services
Diabetes monitoring supplies:
  • In-network:  You pay nothing
  • Out-of-network:  40% of the cost
Diabetes self-management training:
  • In-network:  You pay nothing
  • Out-of-network:  40% of the cost
Therapeutic shoes or inserts:
  • In-network:  20% of the cost
  • Out-of-network:  40% of the cost
Diagnostic Tests, Lab and Radiology Services, and X-Rays
Diagnostic radiology services (such as MRIs CT scans):
  • In-network:  20% of the cost
  • Out-of-network:  $13-21 copay or 40% of the cost depending on the service
Diagnostic tests and procedures:
  • In-network:  20% of the cost
  • Out-of-network:  $13-21 copay or 40% of the cost depending on the service
Lab services:
  • In-network:  $13 copay
  • Out-of-network:  $13-21 copay or 40% of the cost depending on the service
Outpatient x-rays:
  • In-network:  $16 copay
  • Out-of-network:  $13-21 copay or 40% of the cost depending on the service
Therapeutic radiology services (such as radiation treatment for cancer):
  • In-network:  20% of the cost
  • Out-of-network:  $13-21 copay or 40% of the cost depending on the service
Doctor&rsuo;s Office Visits
Primary care physician visit:
  • In-network:  $20 copay
  • Out-of-network:  $35 copay
Specialist visit:
  • In-network:  $50 copay
  • Out-of-network:  $70 copay
Durable Medical Equipment (wheelchairs, oxygen, etc.)
  • In-network:  20% of the cost
Emergency Care
$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.
Foot Care (podiatry services)
Foot exams and treatment if you have diabetes-related nerve damage and/or meet certain conditions:
  • In-network:  $50 copay
  • Out-of-network:  $70 copay
Routine foot care:
  • In-network:  $50 copay. You are covered for up to 6 visit(s) every year.
  • Out-of-network:  $70 copay.  There may be a limit to how often these services are covered.
Hearing Services
Exam to diagnose and treat hearing and balance issues:
  • In-network:  $50 copay
  • Out-of-network:  $70 copay
Routine hearing exam:
  • In-network:  $20 copay. You are covered for up to 1 every year.
  • Out-of-network:  $70 copay.  There may be a limit to how often these services are covered.
Hearing aid:
  • In-network:  $330-380 copay for each hearing aid depending on the type
Home Health Care
  • In-network:  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.
  • In-network:  
    • $395 copay per day for days 1 through 3
    • You pay nothing per day for days 4 through 90
      • Out-of-network:  
        • 40% of the cost per stay
        • Outpatient group therapy visit:
          • In-network:  $30 copay
          • Out-of-network:  $35-45 copay depending on the service
          Outpatient individual therapy visit:
          • In-network:  $40 copay
          • Out-of-network:  $35-45 copay depending on the service
          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):
          • In-network:  $50 copay
          • Out-of-network:  $70 copay
          Occupational therapy visit:
          • In-network:  $40 copay
          • Out-of-network:  $70 copay
          Physical therapy and speech and language therapy visit:
          • In-network:  $40 copay
          • Out-of-network:  $70 copay
          Outpatient Substance Abuse
          Group therapy visit:
          • In-network:  $30 copay
          • Out-of-network:  $35-45 copay depending on the service
          Individual therapy visit:
          • In-network:  $40 copay
          • Out-of-network:  $35-45 copay depending on the service
          Outpatient Surgery
          Ambulatory surgical center:
          • In-network:  20% of the cost
          • Out-of-network:  40% of the cost
          Outpatient hospital:
          • In-network:  20% of the cost
          • Out-of-network:  40% of the cost
          Over-the-Counter Items
          Not Covered
          Prosthetic Devices (braces, artificial limbs, etc.)
          Prosthetic devices:
          • In-network:  20% of the cost
          • Out-of-network:  40% of the cost
          Related medical supplies:
          • In-network:  20% of the cost
          • Out-of-network:  40% of the cost
          Renal Dialysis
          • In-network:  20% of the cost
          Transportation
          Not covered
          Urgently Needed Care
          $30-40 copay depending on the service
          Vision Services
          Exam to diagnose and treat diseases and conditions of the eye (including yearly glaucoma screening):
          • In-network:  $0-50 copay depending on the service
          • Out-of-network:  $70 copay
          Routine eye exam:
          • In-network:  $50 copay. You are covered for up to 1 every year.
          • Out-of-network:  $70 copay.  There may be a limit to how often these services are covered.
          Eyeglasses or contact lenses after cataract surgery:
          • In-network:  You pay nothing
          • Out-of-network:  40% of the cost
          ** 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
          • In-network:  You pay nothing
          • Out-of-network:  0-40% of the cost depending on the service
          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.
          ** Inpatient Care **
          Inpatient Hospital Care
          Our plan covers an unlimited number of days for an inpatient hospital stay.
          • In-network:  
            • $395 copay per day for days 1 through 4
            • You pay nothing per day for days 5 through 90
            • You pay nothing per day for days 91 and beyond
              • Out-of-network:  
                • 40% of the cost per stay
                • 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.
                  • In-network:  
                    • You pay nothing per day for days 1 through 20
                    • $155 copay per day for days 21 through 64
                    • You pay nothing per day for days 65 through 100
                    • Outpatient Prescription Drugs
                      For Part B drugs such as chemotherapy drugs:
                      • In-network:  20% of the cost
                      • Out-of-network:  40% of the cost
                      Other Part B drugs:
                      • In-network:  20% of the cost
                      • Out-of-network:  40% of the cost
                      After you pay your yearly deductible you pay the following until your total yearly drug costs reach $2 960. Total yearly drug costs are the total drug costs paid by both you and our Part D plan.
                      You may get your drugs at network retail pharmacies and mail order pharmacies.
                      Standard Retail Cost-Sharing
                      TierOne-month supplyThree-month supply
                      Tier 1 (Preferred Generic)$2 copay$6 copay
                      Tier 2 (Non-Preferred Generic)$8 copay$24 copay
                      Tier 3 (Preferred Brand)$45 copay$135 copay
                      Tier 4 (Non-Preferred Brand)$95 copay$285 copay
                      Tier 5 (Specialty Tier)33% of the cost33% of the cost
                      Preferred Mail Order Cost-Sharing
                      TierThree-month supply
                      Tier 1 (Preferred Generic)$4 copay
                      Tier 2 (Non-Preferred Generic)$16 copay
                      Tier 3 (Preferred Brand)$125 copay
                      Tier 4 (Non-Preferred Brand)$275 copay
                      Tier 5 (Specialty Tier)33% of the cost
                      Standard Mail Order Cost-Sharing
                      TierThree-month supply
                      Tier 1 (Preferred Generic)$6 copay
                      Tier 2 (Non-Preferred Generic)$24 copay
                      Tier 3 (Preferred Brand)$135 copay
                      Tier 4 (Non-Preferred Brand)$285 copay
                      Tier 5 (Specialty Tier)33% of the cost
                      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 but may pay more than you pay at an in-network pharmacy.
                      Most Medicare drug plans have a coverage gap (also called the "donut hole"). This means that there's a temporary change in what you will pay for your drugs. The coverage gap begins after the total yearly drug cost (including what our plan has paid and what you have paid) reaches $2 960.

                      After you enter the coverage gap you pay 45% of the plan's cost for covered brand name drugs and 65% of the plan's cost for covered generic drugs until your costs total $4 700 which is the end of the coverage gap. Not everyone will enter the coverage gap.

                      After your yearly out-of-pocket drug costs (including drugs purchased through your retail pharmacy and through mail order) reach $4 700 you pay the greater of:
                      • 5% of the cost or
                      • $2.65 copay for generic (including brand drugs treated as generic) and a $6.60 copayment for all other drugs.
                      ** Outpatient Care **
                      Diabetes Supplies and Services
                      Diabetes monitoring supplies:
                      • In-network:  You pay nothing
                      • Out-of-network:  40% of the cost
                      Diabetes self-management training:
                      • In-network:  You pay nothing
                      • Out-of-network:  40% of the cost
                      Therapeutic shoes or inserts:
                      • In-network:  20% of the cost
                      • Out-of-network:  40% of the cost
                      Foot Care (podiatry services)
                      Foot exams and treatment if you have diabetes-related nerve damage and/or meet certain conditions:
                      • In-network:  $50 copay
                      • Out-of-network:  $70 copay
                      Routine foot care:
                      • In-network:  $50 copay. You are covered for up to 6 visit(s) every year.
                      • Out-of-network:  $70 copay.  There may be a limit to how often these services are covered.
                      Hearing Services
                      Exam to diagnose and treat hearing and balance issues:
                      • In-network:  $50 copay
                      • Out-of-network:  $70 copay
                      Routine hearing exam:
                      • In-network:  $20 copay. You are covered for up to 1 every year.
                      • Out-of-network:  $70 copay.  There may be a limit to how often these services are covered.
                      Hearing aid:
                      • In-network:  $330-380 copay for each hearing aid depending on the type
                      ** Outpatient Medical Services and Supplies **
                      Outpatient Substance Abuse
                      Group therapy visit:
                      • In-network:  $30 copay
                      • Out-of-network:  $35-45 copay depending on the service
                      Individual therapy visit:
                      • In-network:  $40 copay
                      • Out-of-network:  $35-45 copay depending on the service
                      Prosthetic Devices (braces, artificial limbs, etc.)
                      Prosthetic devices:
                      • In-network:  20% of the cost
                      • Out-of-network:  40% of the cost
                      Related medical supplies:
                      • In-network:  20% of the cost
                      • Out-of-network:  40% of the cost
                      ** Additional Benefits **
                      Inpatient Mental Health Care
                      For inpatient mental health care see the "Mental Health Care" section.
                      ** Cost **
                      Monthly Premium, Deductible, and Limits on How Much You Pay for Covered Services
                      Package 1: Dental Platinum Rider
                      Benefits include:
                      • Preventive Dental
                      • Comprehensive Dental
                      Additional $37.00 per month. You must keep paying your Medicare Part B premium and your $39 monthly plan premium.
                      This package has deductibles for some services.
                      Our plan has a coverage limit for certain benefits.
                      ** Important Information **
                      Package 1: Dental Platinum Rider
                      Benefits include:
                      • Preventive Dental
                      • Comprehensive Dental
                      Additional $37.00 per month. You must keep paying your Medicare Part B premium and your $39 monthly plan premium.
                      This package has deductibles for some services.
                      Our plan has a coverage limit for certain benefits.

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