Rocky Mountain Thrifty Plan + Rx (Cost) By Rocky Mountain Health Plans
Rocky Mountain Thrifty Plan + Rx (Cost) is a 2015 Medicare Advantage ("Part C" or "MA Plan") plan by Rocky Mountain Health Plans. This plan from Rocky Mountain Health Plans works with Medicare to give you significant coverage beyond Part A and Part B benefits. If you decide to sign up for Rocky Mountain Thrifty Plan + Rx (Cost) you still retain Original Medicare. But you will get additional Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance) coverage from Rocky Mountain Health Plans and not Original Medicare. With Medicare Advantage plans your always covered for urgently needed and emergency care and you receive all of the benefits of Original Medicare from this plan except hospice care. Original Medicare still provides you with hospice care even if you sign up for a Medicare Advantage Plan.
2015 Medicare Advantage Plan Details
| Plan Name: | Rocky Mountain Thrifty Plan + Rx (Cost) |
|---|---|
| Plan ID: | H0602-039 |
| Provider: | Rocky Mountain Health Plans |
| Plan Year: | 2015 |
| Plan Type: | Cost |
| Monthly Premium C+D: | $89.40 |
| MOOP: | $6,000 |
Coverage Area for Rocky Mountain Thrifty Plan + Rx (Cost)
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The Rocky Mountain Thrifty Plan + Rx (Cost) H0602-039 is available to residents in Colorado, and has a in-network Maximum Out-of-Pocket limit of $6,000 MOOP. This means that if you get sick or need a high cost procedure your co-pays are capped. If you enroll in Rocky Mountain Thrifty Plan + Rx (Cost) plan you will stop paying co-pays for the rest of the year once you pay out of pocket $6,000 This is a very nice safety net. This plan includes additional Medicare prescription drug (Part-D) coverage.
Rocky Mountain Thrifty Plan + Rx (Cost) is a Cost plan. A Cost plan is operated by a Health Maintenance Organization (HMO) in accordance with a cost reimbursement contract. A Medicare Cost Plan is a type of HMO. These plans may work in much the same way, and have some of the same rules, as Medicare Advantage Plans. You may use the cost plans network of providers or receive their health care services through Original Medicare. With a Cost Plan, if you go to a non-network provider, the services are covered under Original Medicare. You would pay the Medicare Part A and Part B coinsurance and deductibles.
Ratings for Rocky Mountain Thrifty Plan + Rx (Cost) H0602
| 2015 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 Rocky Mountain Thrifty Plan + Rx (Cost) Plans Performance
| Total Rating | ||
|---|---|---|
| Members Leaving the Plan | ||
| Complaints about Health Plan | ||
| Health Plan Quality Improvement |
Health Plan Customer Service Rating for Rocky Mountain Thrifty Plan + Rx (Cost)
| Total Customer Service Rating | ||
|---|---|---|
| Timely Decisions About Appeals | ||
| Reviewing Appeals Decisions |
Staying Healthy, Screening, Testing, & Vaccines
| Total Preventative Rating | ||
|---|---|---|
| Breast Cancer Screening | ||
| Colorectal Cancel Screening | ||
| Cardiovascular Screening | ||
| Diabetes Care | ||
| Annual Flu Vaccine | ||
| Improving Physical | ||
| Improving Mental Health | ||
| Monitoring Physical Activity | ||
| Adult BMI Assessment |
Ratings For Managing Chronic And Long Term Care
| 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 | ||
| Diabetes Care - Cholesterol | ||
| Controlling Blood Pressure | ||
| Rheumatoid Arthritis | ||
| Improving Bladder Control | ||
| Reducing Risk of Falling | ||
| Plan - Cause Readmissions |
Ratings For 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 | ||
| Diabetes Treatment | ||
| Drug Adherence for Diabetes Medications | ||
| Drug Adherence for Hypertension (RAS antagonists) | ||
| Drug Adherence for Cholesterol (Statins) |
Ratings For Member Complaints and Changes in the Drug Plans Performance
| Total Rating | ||
|---|---|---|
| Complaints about the Drug Plan | ||
| Members Choosing to Leave the Plan | ||
| Drug Plan Quality Improvement |
Rocky Mountain Thrifty Plan + Rx (Cost) Drug Plan Customer Service ratings
| Total Rating | ||
|---|---|---|
| Appeals Auto Forward | ||
| Appeals Upheld |
Part-C Premium
Rocky Mountain Health Plans plan charges a 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 Rocky Mountain Thrifty Plan + Rx (Cost) plan has a monthly drug premium of $52.60 and a $75.00 drug deductible. This Rocky Mountain Health Plans plan offers a $52.60 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 $1.80 this Premium covers any enhanced plan benefits offered by Rocky Mountain Health Plans 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 $54.40. 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 Rocky Mountain Thrifty Plan + Rx (Cost) medicare insurance plan offers a $25.50 premium obligation if you receive a full low-income subsidy (LIS) assistance. And the payment is $32.70 for 75% low income subsidy $39.90 for 50% and $47.20 for 25%.
| Part C Premium: | |
|---|---|
| Part D (Drug) Premium: | $52.60 |
| Part D Supplemental Premium | $1.80 |
| Total Part D Premium: | $54.40 |
| Drug Deductible: | $75.00 |
| 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: | $25.50 |
| 75% LIS Premium: | $32.70 |
| 50% LIS Premium: | $39.90 |
| 25% LIS Premium: | $47.20 |
| Inital Coverage Limit: | $2960 |
| Gap Coverage: | No |
Gap Coverage
In 2015 once you and your plan provider have spent $2,960 on covered drugs. (combined amount plus your deductible) You will be in the coverage gap. (AKA "donut hole") You will still receive a 55% discount on brand-name drugs and a 35% discount on generic drugs. Once you reach the coverage gap you will pay 45% of the plan's cost for covered brand-name prescription drugs unless your plan offers additional coverage. This Rocky Mountain Health Plans plan does not offer additional coverage through the gap.
Source: CMS.
Plans as of September 2, 2014.
Star Rating as of Oct 3, 2014.
For More Information on Ratings Please See the CMS Tech Notes Here.
Notes: Data are subject to change. All contracts for 2015 have been finalized. For 2015, enhanced alternative plans may offer additional cost sharing reductions in the gap on a sub-set of the formulary drugs, beyond the standard Part D benefit
Includes 2015 approved contracts/plans. Employer sponsored 800 series plans and plans under sanction are excluded.