2016 Medicare Advantage Rocky Mountain Standard Plan (Cost)
Rocky Mountain Standard Plan (Cost) H0602-001 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 Rocky Mountain Standard Plan (Cost) has a monthly premium of $75.00 and has a in-network Maximum Out-of-Pocket limit of $4,500 (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 $4,500 this can be a very nice safety net.
Rocky Mountain Standard 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 Rocky Mountain Standard 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.
2016 Rocky Mountain Health Plans Medicare Advantage Plan Details
Plan Name: | Rocky Mountain Standard Plan (Cost) |
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Plan ID: | H0602-001 |
Provider: | Rocky Mountain Health Plans |
Parent: | Rocky Mountain HMO, Inc. |
Plan Year: | 2016 |
Plan Type: | Cost * |
Monthly Premium C+D: | $75.00 |
MOOP: | $4,500 |
Plan Services
Monthly premium deductible and limits on how much you pay for covered services
- $4 500 for services you receive from in-network providers.
Doctor's office visits
Durable medical equipment (wheelchairs oxygen etc.)
Emergency care
Foot care (podiatry services)
Hearing services
Home health care
Mental health care
- $700 copay per stay
Outpatient rehabilitation
Outpatient substance abuse
Outpatient surgery
Acupuncture
Over-the-counter items
Prosthetic devices (braces artificial limbs etc.)
Renal dialysis
Transportation
Urgently needed services
Vision services
Preventive care
- 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
Hospice
Inpatient hospital care
- $700 copay per stay
Inpatient mental health care
Skilled Nursing Facility (SNF)
- You pay nothing per day for days 1 through 20
- $95 copay per day for days 21 through 100
Outpatient prescription drugs
Ambulance
Chiropractic care
Dental services
Diabetes supplies and services
Diagnostic tests lab and radiology services and x-rays (Costs for these services may be different if received in an outpatient surgery setting)
Coverage Area for Rocky Mountain Standard Plan (Cost)
(Click county to compare all available plans)
Ratings for Rocky Mountain Standard Plan (Cost) H0602
2016 Overall Rating | ||
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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 Standard 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 Rocky Mountain Standard 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 |
Rocky Mountain Standard 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.