2018 Advantra Silver (PPO) H5522-004 By HealthAmerica

2018 Medicare Advantage Advantra Silver (PPO)

Advantra Silver (PPO) H5522-004 is a 2018 Medicare Advantage or Medicare Part-C plan by HealthAmerica available to residents in Pennsylvania. This plan includes additional Medicare prescription drug (Part-D) coverage. The Advantra Silver (PPO) has a monthly premium of $0.00 and has a in-network Maximum Out-of-Pocket limit of $6,700 (MOOP). This means that if you get sick or need a high cost procedure your co-pays are capped once you pay out of pocket $6,700 this can be a very nice safety net.

Advantra Silver (PPO) is a Local PPO. A preferred provider organization (PPO) is a Medicare plan that has created contracts with a network of "preferred" providers for you to choose from at reduced rates. You do not need to select a primary care physician and you do not need referrals to see other providers in the network. Offering you a little more flexibility overall. You can get medical attention from a provider outside of the network but you will have to pay the difference between the out-of-network bill and the PPOs discounted rate.

HealthAmerica works with Medicare to give you significant coverage beyond Part A and Part B benefits. If you decide to sign up for Advantra Silver (PPO) you still retain Original Medicare. But you will get additional Part A (Hospital Insurance) and Part B (Medical Insurance) coverage from HealthAmerica and not Original Medicare. With Medicare Advantage your always covered for urgently needed and emergency care and you receive all of the benefits of Original Medicare from HealthAmerica except hospice care. Original Medicare still provides you with hospice care even if you sign up for a Medicare Advantage Plan.



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2018 HealthAmerica Medicare Advantage Plan Details

Name:
Advantra Silver (PPO)
ID:
H5522-004
Provider:HealthAmerica
Year:2018
Type: Local PPO
Monthly Premium C+D: $0.00
MOOP: $6,700




Plan Services






Health plan deductible


$1,000 annual deductible



Diagnostic procedures/lab services/imaging


Diagnostic tests and procedures In-Network $20
Diagnostic tests and procedures Out-of-Network 40%
Lab services In-Network $5
Lab services Out-of-Network 40%
Diagnostic radiology services (e.g., MRI) In-Network $265
Diagnostic radiology services (e.g., MRI) Out-of-Network 40%
Outpatient x-rays In-Network $25
Outpatient x-rays Out-of-Network 40%



Hearing


Hearing exam In-Network $40
Hearing exam Out-of-Network 40%
Fitting/evaluation Not covered
Hearing aids - inner ear Not covered
Hearing aids - outer ear Not covered
Hearing aids - over the ear Not covered



Preventive dental


Oral exam Not covered
Cleaning Not covered
Fluoride treatment Not covered
Dental x-ray(s) Not covered



Comprehensive dental


Non-routine services Not covered
Diagnostic services Not covered
Restorative services Not covered
Endodontics Not covered
Periodontics Not covered
Extractions Not covered
Prosthodontics, other oral/maxillofacial surgery, other services Not covered



Vision


Routine eye exam In-Network $0 copay
Routine eye exam Out-of-Network 40%
Other Not covered
Contact lenses Not covered
Eyeglasses (frames and lenses) Not covered
Eyeglass frames Not covered
Eyeglass lenses Not covered
Upgrades Not covered



Mental health services


In-Network $1,590 per stay
Out-of-Network 40% per stay
Outpatient group therapy visit with a psychiatrist In-Network $40
Outpatient group therapy visit with a psychiatrist Out-of-Network 45%
Outpatient individual therapy visit with a psychiatrist In-Network $40
Outpatient individual therapy visit with a psychiatrist Out-of-Network 45%
Outpatient group therapy visit In-Network $40
Outpatient group therapy visit Out-of-Network 45%
Outpatient individual therapy visit In-Network $40
Outpatient individual therapy visit Out-of-Network 45%



Skilled Nursing Facility


In-Network $0 for days 1 through 20
$167.50 for days 21 through 100
Out-of-Network 40% per stay



Rehabilitation services


Occupational therapy visit In-Network $40
Occupational therapy visit Out-of-Network 40%
Physical therapy and speech and language therapy visit In-Network $40
Physical therapy and speech and language therapy visit Out-of-Network 40%



Ambulance


In-Network $275
Out-of-Network $275



Transportation


Not covered



Other health plan deductibles?


In-Network No



Foot care (podiatry services)


Foot exams and treatment In-Network $40
Foot exams and treatment Out-of-Network 40%
Routine foot care In-Network $40
Routine foot care Out-of-Network 40%



Medical equipment/supplies


Durable medical equipment (e.g., wheelchairs, oxygen) In-Network 20% per item
Durable medical equipment (e.g., wheelchairs, oxygen) Out-of-Network 40% per item
Prosthetics (e.g., braces, artificial limbs) In-Network 20% per item
Prosthetics (e.g., braces, artificial limbs) Out-of-Network 40% per item
Diabetes supplies In-Network 0-20% per item
Diabetes supplies Out-of-Network 0-20% per item



Wellness programs (e.g., fitness, nursing hotline)


Covered



Medicare Part B drugs


Chemotherapy In-Network 20%
Chemotherapy Out-of-Network 40%
Other Part B drugs In-Network 20%
Other Part B drugs Out-of-Network 40%



Maximum out-of-pocket enrollee responsibility (does not include prescription drugs)


$10,000 In and Out-of-network
$6,700 In-network



Optional supplemental benefits


No



Inpatient hospital coverage


In-Network $185 for days 1 through 9
$0 for days 10 through 90
Out-of-Network 40% per stay



Outpatient hospital coverage


In-Network $350 per visit
Out-of-Network 40% per visit



Doctor visits


Primary In-Network $10 per visit
Primary Out-of-Network 40% per visit
Specialist In-Network $35 per visit
Specialist Out-of-Network 40% per visit



Preventive care


In-Network $0 copay
Out-of-Network 0-40%



Emergency care/Urgent care


Emergency $80 per visit (always covered)
Urgent care $50 per visit (always covered)






Ratings for Advantra Silver (PPO) H5522

2018 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 Advantra Silver (PPO) Plans Performance

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


Health Plan Customer Service Rating for Advantra Silver (PPO)

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 Cancer 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
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


Advantra Silver (PPO) Drug Plan Customer Service ratings

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


Part-C Premium

HealthAmerica 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

Advantra Silver (PPO) has a monthly drug premium of $0.00 and a $0.00 drug deductible. This HealthAmerica plan offers a $0.00 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 HealthAmerica 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 $0.00. 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 Advantra Silver (PPO) medicare insurance offers a $0.00 premium obligation if you receive a full low-income subsidy (LIS) assistance. And the payment is $0.00 for 75% low income subsidy $0.00 for 50% and $0.00 for 25%.



Part C Premium: $0.00
Part D (Drug) Premium: $0.00
Part D Supplemental Premium $0.00
Total Part D Premium: $0.00
Drug Deductible: $0.00
Tiers with No Deductible: 0
Benchmark: not below the regional benchmark
Type of Medicare Health: Enhanced Alternative
Drug Benefit Type: Enhanced
Full LIS Premium: $0.00
75% LIS Premium: $0.00
50% LIS Premium: $0.00
25% LIS Premium: $0.00
Initial Coverage Limit:$3750
Gap Coverage: Yes


Gap Coverage

In 2018 once you and your plan provider have spent $3750 on covered drugs. (combined amount plus your deductible) You will be in the coverage gap. (AKA "donut hole") You will be required to pay 35% for brand-name drugs and 44% on generic drugs unless your plan offers additional coverage. This HealthAmerica plan does offer additional coverage through the gap.



Coverage Area for Advantra Silver (PPO)

(Click county to compare all available Advantage plans)





Source: CMS.

Data as of September 2, 2017.

Star Rating as of September 6, 2017.

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

Notes: Data are subject to change as contracts are finalized. For 2018, enhanced alternative may offer additional cost sharing reductions in the gap on a sub-set of the formulary drugs, beyond the standard Part D benefit.

Includes 2018 approved contracts. Employer sponsored 800 series and plans under sanction are excluded.

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  • Mon-Fri 8:30am-8:00pm
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