2017 Sunshine Health Medicare Advantage (HMO SNP) EA-H5190

Sunshine Health Medicare Advantage (HMO SNP) By Sunshine Health Medicare Advantage



Sunshine Health Medicare Advantage (HMO SNP) is a 2017 Medicare Advantage Special Needs Plan plan by Sunshine Health Medicare Advantage. This plan from Sunshine Health Medicare Advantage works with Medicare to give you significant coverage beyond original Medicare. If you decide to sign up you still retain Original Medicare. But you will get additional Part A (Hospital Insurance) and Part B (Medical Insurance) coverage from Sunshine Health Medicare Advantage and not Original Medicare. All Medicare SNPs also provide Medicare additional Part-D drug coverage. Sunshine Health Medicare Advantage (HMO SNP) EA-H5190 is a Dual Eligible Special Needs Plan (D-SNP). A Dual Eligible SNP is for beneficiaries who are eligible for both Medicare and Medicaid. If you have Medicare and get help from Medicaid you can join any Medicare SNP you qualify for or switch plans at any time.



2017 Medicare Special Needs Plan Details

Plan Name:
Sunshine Health Medicare Advantage (HMO SNP)
Plan ID:
EA-H5190
Special Needs Type: Dual-Eligible
Provider: Sunshine Health Medicare Advantage
Plan Year:2017
Plan Type: Local HMO
Monthly Premium C+D: $29.10


COMPARE AND SAVE ON MEDICARE INSURANCE




Coverage Area for Sunshine Health Medicare Advantage (HMO SNP)

State: Florida
County:Miami Dade,


The Sunshine Health Medicare Advantage (HMO SNP) EA-H5190 is available to residents in Florida, and all Medicare SNPs must provide Medicare additional prescription drug (Part-D) coverage. Sunshine Health Medicare Advantage (HMO SNP) is a Local HMO. With a health maintenance organization (HMO) you will be required to receive most of your health care from an in-network provider. Health maintenance organizations require that you select a primary care physician (PCP). Your PCP will serve as your personal doctor to provide all of your basic healthcare services. If you need special care for a physician specialist, your primary care physician will make the arrangements and tell you where you can go in the network. You will need your PCPs okay, called a referral. Without getting a referral or services received from out-of-network providers are not typically covered by the plan.





Part-C Premium

Sunshine Health Medicare Advantage plan charges a $0.00 Part-C premium. The Part C premium covers Medicare medical, hospital benefits and supplemental benefits if offered. You generally are also responsible for paying the Part B premium.



Part-D Deductible and Premium

The Sunshine Health Medicare Advantage (HMO SNP) plan has a monthly drug premium of $29.10 and a $400.00 drug deductible. This Sunshine Health Medicare Advantage plan offers a $29.10 Part D Basic Premium that is not below the regional benchmark. This covers the basic prescription benefit only and does not cover enhanced drug benefits such as medical benefits or hospital benefits. The Part D Supplemental Premium is $0.00 this Premium covers any enhanced plan benefits offered by Sunshine Health Medicare Advantage above and beyond the standard PDP benefits. This can include additional coverage in the gap, lower co-payments and coverage of non-Part D drugs. The Part D Total Premium is $29.10. The Part D Total Premium is the addition of the supplemental and basic premiums for some plans this amount can be lower due to negative basic or supplemental premiums.



Premium Assistance

Depending on your income level you may be eligible for full 75%, 50%, 25% premium assistance. The Sunshine Health Medicare Advantage (HMO SNP) medicare insurance plan offers a $0.00 premium obligation if you receive a full low-income subsidy (LIS) assistance. And the payment is $7.30 for 75% low income subsidy $14.50 for 50% and $21.80 for 25%.



Part C Premium: $0.00
Part D (Drug) Premium: $29.10
Part D Supplemental Premium $0.00
Total Part D Premium: $29.10
Drug Deductible: $400.00
Tiers with No Deductible: 1
Benchmark: not below the regional benchmark
Type of Medicare Health Plan: Enhanced Alternative
Drug Benefit Type: Enhanced
Full LIS Premium: $0.00
75% LIS Premium: $7.30
50% LIS Premium: $14.50
25% LIS Premium: $21.80
Initial Coverage Limit:$3700
Gap Coverage: Yes


Gap Coverage

In 2017 once you and your plan provider have spent $3,700 on covered drugs. (combined amount plus your deductible) You will be in the coverage gap. (AKA "donut hole") You will be required to pay 40% for brand-name drugs and 51% on generic drugs unless your plan offers additional coverage. This Sunshine Health Medicare Advantage plan does offer additional coverage through the gap.



Ratings for Sunshine Health Medicare Advantage (HMO SNP) EA

2017 Overall Rating
Part C Summary Rating
Part D Summary Rating
Staying Healthy: Screenings, Tests, Vaccines
Managing Chronic (Long Term) Conditions
Member Experience with Health Plan
Complaints and Changes in Plans Performance
Health Plan Customer Service
Drug Plan Customer Service
Complaints and Changes in the Drug Plan
Member Experience with the Drug Plan
Drug Safety and Accuracy of Drug Pricing


Member Experience with Health Plan

Total Experience Rating
Getting Needed Care
Timely Care and Appointments
Customer Service
Health Care Quality
Rating of Health Plan
Care Coordination


Member Complaints and Changes in Sunshine Health Medicare Advantage (HMO SNP) Plans Performance

Total Rating
Members Leaving the Plan
Complaints about Health Plan
Beneficiary Access
Health Plan Quality Improvement


Health Plan Customer Service Rating for Sunshine Health Medicare Advantage (HMO SNP)

Total Customer Service Rating
Timely Decisions About Appeals
Reviewing Appeals Decisions
Call Center, TTY, Foreign Language


Staying Healthy, Screening, Testing, & Vaccines

Total Preventative Rating
Breast Cancer Screening
Colorectal Cancel Screening
Annual Flu Vaccine
Improving Physical
Improving Mental Health
Monitoring Physical Activity
Adult BMI Assessment


Managing Chronic And Long Term Care for Older Adults

Total Rating
SNP Care Management
Medication Review
Functional Status Assessment
Pain Screening
Osteoporosis Management
Diabetes Care - Eye Exam
Diabetes Care - Kidney Disease
Diabetes Care - Blood Sugar
Controlling Blood Pressure
Rheumatoid Arthritis
Improving Bladder Control
Reducing Risk of Falling
Plan - Cause Readmissions


Member Experience with the Drug Plan

Total Rating
Rating of Drug Plan
Getting Needed Prescription Drugs


Drug Safety and Accuracy of Drug Pricing

Total Rating
MPF Price Accuracy
High Risk Medication
Drug Adherence for Diabetes Medications
Drug Adherence for Hypertension (RAS antagonists)
Drug Adherence for Cholesterol (Statins)
MTM Program Completion Rate for CMR


Ratings For Member Complaints and Changes in the Drug Plans Performance

Total Rating
Complaints about the Drug Plan
Members Choosing to Leave the Plan
Beneficiary Access
Drug Plan Quality Improvement


Sunshine Health Medicare Advantage (HMO SNP) Drug Plan Customer Service ratings

Total Rating
Appeals Auto Forward
Appeals Upheld
Call Center, TTY, Foreign Language


Source: CMS.

Plans as of September 6, 2016.

Star Rating as of September 26, 2016.

For More Information on Ratings Please See the CMS Tech Notes Here.

Notes: Data are subject to change. All contracts for 2017 have not been finalized. For 2017, enhanced alternative plans may offer additional cost sharing reductions in the gap on a sub-set of the formulary drugs, beyond the standard Part

Includes 2017 approved contracts/plans. Employer sponsored 800 series plans and plans under sanction are excluded.

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