CareHeart (HMO SNP) By CarePlus Health Plans, Inc.
CareHeart (HMO SNP) is a 2014 Medicare Advantage Special Needs Plan plan by CarePlus Health Plans, Inc.. This plan from CarePlus Health Plans, Inc. 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 CarePlus Health Plans, Inc. and not Original Medicare. All Medicare SNPs also provide Medicare additional Part-D drug coverage. CareHeart (HMO SNP) H1019-062 is a Chronic Condition SNP (C-SNP). A Chronic Condition SNP is for beneficiaries with the following severe or disabling chronic conditions: Cardiovascular Disorders and Chronic Heart Failure. If you have Medicare and you develop certain severe or disabling conditions you can join a Medicare SNP designed to serve people with those conditions at any time.
2014 Medicare Special Needs Plan Details
| Plan Name: | CareHeart (HMO SNP) |
|---|---|
| Plan ID: | H1019-062 |
| Special Needs Type: | Chronic or Disabling Condition |
| Provider: | CarePlus Health Plans, Inc. |
| Plan Year: | 2014 |
| Plan Type: | Local HMO |
| Monthly Premium C+D: | $- |
| Chronic Condition: | Cardiovascular Disorders and Chronic Heart Failure |
Coverage Area for CareHeart (HMO SNP)
The CareHeart (HMO SNP) H1019-062 is available to residents in Florida, and all Medicare SNPs must provide Medicare additional prescription drug (Part-D) coverage. CareHeart (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.
Total Ratings for CareHeart (HMO SNP) H1019
| 2014 Overall Rating | ||
|---|---|---|
| Part C Summary Rating | ||
| Total Experience Rating | ||
| Complaints, Improvements | ||
| Total Customer Service Rating | ||
| Total Preventative Rating | ||
| Chronic And Long Term Care |
Member Experience Rating for CareHeart (HMO SNP)
| Total Experience Rating | ||
|---|---|---|
| Getting Needed Care | ||
| Timely Care and Appointments | ||
| Customer Service | ||
| Health Care Quality | ||
| Rating of Health Plan | ||
| Care Coordination |
Member Complaints, Problems Getting Service and Improvements in Health Plans
| Total Rating | ||
|---|---|---|
| Members Leaving the Plan | ||
| Complaints about Health Plan | ||
| Access to Service | ||
| Performance Problems | ||
| Health Plan Quality Improvement |
Customer Service Rating for CareHeart (HMO SNP)
| Total Customer Service Rating | ||
|---|---|---|
| Timely Decisions About Appeals | ||
| Reviewing Appeals Decisions | ||
| Call Center |
Staying Healthy, Screening, Testing, & Vaccines
| Total Preventative Rating | ||
|---|---|---|
| Breast Cancer Screening | ||
| Colorectal Cancel Screening | ||
| Cardiovascular Screening | ||
| Diabetes Care | ||
| Glaucoma Testing | ||
| Annual Flu Vaccine | ||
| Improving Physical | ||
| Improving Mental Health | ||
| Monitoring Physical Activity | ||
| Adult BMI Assessment |
Ratings For Managing Chronic And Long Term Care
| Total Rating | ||
|---|---|---|
| Medication Review | ||
| Functional Status Assessment | ||
| Pain Screening | ||
| Osteoporosis Management | ||
| Diabetes Care - Eye Exam | ||
| Diabetes Care - Kidney Disease | ||
| Diabetes Care - Blood Sugar | ||
| Diabetes Care - Cholesterol | ||
| Controlling Blood Pressure | ||
| Rheumatoid Arthritis | ||
| Improving Bladder Control | ||
| Reducing Risk of Falling | ||
| Plan - Cause Readmissions |
Part-C Premium
CarePlus Health Plans, Inc. 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 CareHeart (HMO SNP) plan has a monthly drug premium of $0.00 and a $0.00 drug deductible. This CarePlus Health Plans, Inc. 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 CarePlus Health Plans, Inc. 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 CareHeart (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 $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 Plan: | 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 |
| Inital Coverage Limit: | $2850 |
| Gap Coverage: | Some Generics, Few Brands |
Gap Coverage
In 2014 once you and your plan provider have spent $2,850 on covered drugs. (combined amount plus your deductible) You will be in the coverage gap. (AKA "donut hole") You will be require to pay 47.5% of the plan's cost for covered brand-name prescription drugs and 72% of the cost for generic drugs unless your plan offers additional coverage. This CarePlus Health Plans, Inc. plan covers Some Generics, Few Brands through the gap. Some means 10% to 65% of the formulary drugs are covered if you are in the gap. Few means 0% to 10% of the formulary drugs are covered if your are in the gap and must also be greather then 15 "brand" products covered through the gap.
Source: CMS.
Plans as of September 3, 2013.
Star Rating as of September 27, 2013.
For More Information on Ratings Please See the CMS Tech Notes Here.
Plans are subject to change as contracts are finalized.
Includes 2014 approved contracts/plans. Employer sponsored 800 series plans and plans under sanction are excluded.
