2016 AB Basic Plan (Cost) H0602-026 By Rocky Mountain Health Plans

2016 Medicare Advantage AB Basic Plan (Cost)

AB Basic Plan (Cost) H0602-026 is a 2016 Medicare Advantage or Medicare Part-C plan by Rocky Mountain Health Plans available to residents in Colorado. This plan does not provide additional Medicare prescription drug (Part-D) coverage. The AB Basic Plan (Cost) has a monthly premium of $5.00 and has a in-network Maximum Out-of-Pocket limit of N/A (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 N/A this can be a very nice safety net.

AB Basic Plan (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.

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 AB Basic Plan (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.



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2016 Rocky Mountain Health Plans Medicare Advantage Plan Details

Plan Name:
AB Basic Plan (Cost)
Plan ID:
H0602-026
Provider:Rocky Mountain Health Plans
Parent:Rocky Mountain HMO, Inc.
Plan Year:2016
Plan Type: Cost *
Monthly Premium C+D: $5.00
MOOP: N/A




Plan Services



Monthly premium deductible and limits on how much you pay for covered services


$5.00 per month. In addition you must keep paying your Medicare Part B premium. This plan has deductibles for some hospital and medical services. $166 per year for in-network services. No. This plan does not have any limits. No. There are no limits on how much our plan will pay.


Doctor's office visits


Primary care physician visit:  20% of the cost Specialist visit:  20% of the cost


Durable medical equipment (wheelchairs oxygen etc.)


20% of the cost


Emergency care


20% of the cost (up to $75) If you are admitted to the hospital within 3 days 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:  20% of the cost


Hearing services


Exam to diagnose and treat hearing and balance issues:  20% of the cost


Home health care


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. The copays for hospital and skilled nursing facility (SNF) benefits are based on benefit periods. A benefit period begins the day you're admitted as an inpatient and ends when you haven't received any inpatient care (or skilled care in a SNF) for 60 days in a row. If you go into a hospital or a SNF after one benefit period has ended a new benefit period begins. You must pay the inpatient hospital deductible for each benefit period. There's no limit to the number of benefit periods. 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 2016 the amounts for each benefit period are:
  • $1 288 deductible for days 1 through 60
  • $322 copay per day for days 61 through 90
  • $644 copay per day for 60 lifetime reserve days
Outpatient group therapy visit:  20% of the cost Outpatient individual therapy visit:  20% of the cost


Outpatient rehabilitation


Cardiac (heart) rehab services (for a maximum of 2 one-hour sessions per day for up to 36 sessions up to 36 weeks):  20% of the cost Occupational therapy visit:  20% of the cost Physical therapy and speech and language therapy visit:  20% of the cost


Outpatient substance abuse


Group therapy visit:  20% of the cost Individual therapy visit:  20% of the cost


Outpatient surgery


Ambulatory surgical center:  20% of the cost Outpatient hospital:  20% of the cost


Acupuncture


Not covered


Over-the-counter items


Not Covered


Prosthetic devices (braces artificial limbs etc.)


Prosthetic devices:  20% of the cost Related medical supplies:  20% of the cost


Renal dialysis


20% of the cost


Transportation


Not covered


Urgently needed services


20% of the cost (up to $65) If you are admitted to the hospital within 3 days you do not have to pay your share of the cost for urgently needed services. See the "Inpatient Hospital Care" section for other costs.


Vision services


Exam to diagnose and treat diseases and conditions of the eye (including yearly glaucoma screening):  20% of the cost Eyeglasses or contact lenses after cataract surgery:  20% of the cost


Preventive care


You pay nothing 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
  • Colorectal cancer screenings (Colonoscopy Fecal occult blood test Flexible sigmoidoscopy)
  • Depression screening
  • Diabetes screenings
  • 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.


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.


Inpatient hospital care


The copays for hospital and skilled nursing facility (SNF) benefits are based on benefit periods. A benefit period begins the day you're admitted as an inpatient and ends when you haven't received any inpatient care (or skilled care in a SNF) for 60 days in a row. If you go into a hospital or a SNF after one benefit period has ended a new benefit period begins. You must pay the inpatient hospital deductible for each benefit period. There's no limit to the number of benefit periods. 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 2016 the amounts for each benefit period are:
  • $1 288 deductible for days 1 through 60
  • $322 copay per day for days 61 through 90
  • $644 copay per day for 60 lifetime reserve days


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 2016 the amounts for each benefit period are:
  • You pay nothing for days 1 through 20
  • $161 copay per day for days 21 through 100


Outpatient prescription drugs


For Part B drugs such as chemotherapy drugs1:  20% of the cost Other Part B drugs1:  20% of the cost Our plan does not cover Part D prescription drug.


Ambulance


20% of the cost


Chiropractic care


Manipulation of the spine to correct a subluxation (when 1 or more of the bones of your spine move out of position):  20% of the cost


Dental services


Limited dental services (this does not include services in connection with care treatment filling removal or replacement of teeth):  20% of the cost


Diabetes supplies and services


Diabetes monitoring supplies:  20% of the cost Diabetes self-management training:  20% of the cost Therapeutic shoes or inserts:  20% of the cost


Diagnostic tests lab and radiology services and x-rays (Costs for these services may be different if received in an outpatient surgery setting)


Diagnostic radiology services (such as MRIs CT scans):  20% of the cost Diagnostic tests and procedures:  20% of the cost Lab services:  You pay nothing Outpatient x-rays:  20% of the cost Therapeutic radiology services (such as radiation treatment for cancer):  20% of the cost




Coverage Area for AB Basic Plan (Cost)

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Ratings for AB Basic Plan (Cost) H0602

2016 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 AB Basic Plan (Cost) Plans Performance

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


Health Plan Customer Service Rating for AB Basic Plan (Cost)

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


AB Basic Plan (Cost) Drug Plan Customer Service ratings

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


Source: CMS.

Plans as of September 9, 2015

Star Rating as of September 30, 2015.

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

Notes: Data are subject to change as contracts are finalized. For 2016, 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 2016 approved contracts/plans. Employer sponsored 800 series plans and plans under sanction are excluded.

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