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) |
|---|---|
| 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
$75.00 per month. In addition you must keep paying your Medicare Part B premium. This plan has deductibles for some hospital and medical services. Yes. Our plan protects you by having yearly limits on your out-of-pocket costs for medical and hospital care. Your yearly limit(s) in this plan:
- $4 500 for services you receive from in-network providers.
Doctor's office visits
Primary care physician visit: $20 copay Specialist visit: $45 copay
Durable medical equipment (wheelchairs oxygen etc.)
20% of the cost
Emergency care
$65 copay If you are admitted to the hospital within 24 hours 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: $45 copay
Hearing services
Exam to diagnose and treat hearing and balance issues: $20-45 copay depending on the service Routine hearing exam (for up to 1 every year): $20 copay
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.
- $700 copay per stay
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): You pay nothing Occupational therapy visit: $20 copay Physical therapy and speech and language therapy visit: $20 copay
Outpatient substance abuse
Group therapy visit: $45 copay Individual therapy visit: $45 copay
Outpatient surgery
Ambulatory surgical center: $350 copay Outpatient hospital: $350 copay
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
$45 copay
Vision services
Exam to diagnose and treat diseases and conditions of the eye (including yearly glaucoma screening): $0-45 copay depending on the service Routine eye exam (for up to 1 every year): $20 copay Eyeglasses or contact lenses after cataract surgery: You pay nothing
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
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.
- $700 copay per stay
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.
- You pay nothing per day for days 1 through 20
- $95 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
$200 copay
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): $20-700 copay depending on the service after you pay your deductible
Diabetes supplies and services
Diabetes monitoring supplies: 20% of the cost Diabetes self-management training: You pay nothing 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): $75-150 copay depending on the service Diagnostic tests and procedures: $0-350 copay depending on the service Lab services: You pay nothing Outpatient x-rays: $20 copay Therapeutic radiology services (such as radiation treatment for cancer): 20% of the cost
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 | ||
|---|---|---|
| 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.