Care Improvement Plus Dual Advantage (Regional PPO SNP) By Care Improvement Plus
Care Improvement Plus Dual Advantage (Regional PPO SNP) is a 2016 Medicare Advantage Special Needs Plan plan by Care Improvement Plus. This plan from Care Improvement Plus 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 Care Improvement Plus and not Original Medicare. All Medicare SNPs also provide Medicare additional Part-D drug coverage. Care Improvement Plus Dual Advantage (Regional PPO SNP) DS-R3444 is a Dual Eligible Special Needs Plan (D-SNP). A Dual Eligible SNP is for beneficiaries who are eligible for both Medicare and Medicaid. If you have Medicare and get help from Medicaid you can join any Medicare SNP you qualify for or switch plans at any time.
2016 Medicare Special Needs Plan Details
Plan Name: | Care Improvement Plus Dual Advantage (Regional PPO SNP) |
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Plan ID: | DS-R3444 |
Special Needs Type: | Dual-Eligible |
Provider: | Care Improvement Plus |
Parent: | UnitedHealth Group, Inc. |
Plan Year: | 2016 |
Plan Type: | Regional PPO |
Monthly Premium C+D: | $16.70 |
Plan Services
Monthly premium deductible and limits on how much you pay for covered services
- $6 700 for services you receive from in-network providers.
- $6 700 for services you receive from any provider. Your limit for services received from in-network providers will count toward this limit.
Doctor's office visits
- In-network: You pay nothing
- Out-of-network: 20% of the cost
- In-network: You pay nothing
- Out-of-network: 20% of the cost
Durable medical equipment (wheelchairs oxygen etc.)
- In-network: You pay nothing
- Out-of-network: 20% of the cost
Emergency care
Foot care (podiatry services)
- In-network: You pay nothing
- Out-of-network: 20% of the cost
- In-network: You pay nothing
- Out-of-network: You pay nothing
Hearing services
- In-network: You pay nothing
- Out-of-network: 20% of the cost
- In-network: You pay nothing
- Out-of-network: You pay nothing
- In-network: $330-380 copay for each hearing aid depending on the type
- Out-of-network: $330-380 copay for each hearing aid depending on the type
Home health care
- In-network: You pay nothing
- Out-of-network: You pay nothing
Mental health care
- In-network: You pay nothing
- Out-of-network: 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
- In-network: You pay nothing
- Out-of-network: 20% of the cost
- In-network: You pay nothing
- Out-of-network: 20% of the cost
Outpatient rehabilitation
- In-network: You pay nothing
- Out-of-network: 20% of the cost
- In-network: You pay nothing
- Out-of-network: 20% of the cost
- In-network: You pay nothing
- Out-of-network: 20% of the cost
Outpatient substance abuse
- In-network: You pay nothing
- Out-of-network: 20% of the cost
- In-network: You pay nothing
- Out-of-network: 20% of the cost
Outpatient surgery
- In-network: You pay nothing
- Out-of-network: 20% of the cost
- In-network: You pay nothing
- Out-of-network: 20% of the cost
Acupuncture
Over-the-counter items
Prosthetic devices (braces artificial limbs etc.)
- In-network: You pay nothing
- Out-of-network: 20% of the cost
- In-network: You pay nothing
- Out-of-network: 20% of the cost
Renal dialysis
- In-network: You pay nothing
- Out-of-network: 20% of the cost
Transportation
- In-network: You pay nothing
- Out-of-network: You pay nothing
Urgently needed services
Vision services
- In-network: You pay nothing
- Out-of-network: 0-20% of the cost depending on the service
- In-network: You pay nothing
- Out-of-network: You pay nothing
- In-network: You pay nothing
- Out-of-network: You pay nothing
- In-network: You pay nothing
- Out-of-network: You pay nothing
- In-network: You pay nothing
- Out-of-network: 20% of the cost
Preventive care
- In-network: You pay nothing
- Out-of-network: You pay nothing
- 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
- In-network: You pay nothing
Hospice
Inpatient hospital care
- In-network: You pay nothing
- Out-of-network: 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
Skilled Nursing Facility (SNF)
- In-network: You pay nothing
- Out-of-network: 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
- In-network: You pay nothing
- Out-of-network: 20% of the cost
- In-network: You pay nothing
- Out-of-network: 20% of the cost
For generic drugs (including brand drugs treated as generic) either:
For all other drugs either:
You may get drugs from an out-of-network pharmacy at the same cost as an in-network pharmacy.
You pay nothing
Ambulance
- In-network: You pay nothing
- Out-of-network: 20% of the cost
Chiropractic care
- In-network: You pay nothing
- Out-of-network: 20% of the cost
Dental services
- In-network: You pay nothing
- Out-of-network: 20% of the cost
- In-network: You pay nothing
- Out-of-network: You pay nothing
- In-network: You pay nothing
- Out-of-network: You pay nothing
- In-network: You pay nothing
- Out-of-network: You pay nothing
Diabetes supplies and services
- In-network: You pay nothing
- Out-of-network: 20-30% of the cost depending on the supply
- In-network: You pay nothing
- Out-of-network: You pay nothing
- In-network: You pay nothing
- Out-of-network: 20-30% of the cost depending on the supply
Diagnostic tests lab and radiology services and x-rays (Costs for these services may be different if received in an outpatient surgery setting)
- In-network: You pay nothing
- Out-of-network: 20% of the cost
- In-network: You pay nothing
- Out-of-network: 20% of the cost
- In-network: You pay nothing
- Out-of-network: 20% of the cost
- In-network: You pay nothing
- Out-of-network: 20% of the cost
- In-network: You pay nothing
- Out-of-network: 20% of the cost
Coverage Area for Care Improvement Plus Dual Advantage (Regional PPO SNP)
The Care Improvement Plus Dual Advantage (Regional PPO SNP) DS-R3444 is available to residents in Missouri, Arkansas, and all Medicare SNPs must provide Medicare additional prescription drug (Part-D) coverage. Care Improvement Plus Dual Advantage (Regional PPO SNP) is a Regional PPO. A preferred provider organization (PPO) is a medicare plan that has created contracts with a network of "preferred" providers for you to choose from at reduced rates. You do not need to select a primary care physician and you do not need referrals to see other providers in the network. Offering you a little more flexibility overall. You can get medical attention from a provider outside of the network but you will have to pay the difference between the out-of-network bill and the PPOs discounted rate.
Part-C Premium
Care Improvement Plus 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 Care Improvement Plus Dual Advantage (Regional PPO SNP) plan has a monthly drug premium of $16.70 and a $360.00 drug deductible. This Care Improvement Plus plan offers a $16.70 Part D Basic Premium that is 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 Care Improvement Plus 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 $16.70. 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 Care Improvement Plus Dual Advantage (Regional PPO SNP) medicare insurance plan offers a $0.00 premium obligation if you receive a full low-income subsidy (LIS) assistance. And the payment is $4.20 for 75% low income subsidy $8.30 for 50% and $12.50 for 25%.
Part C Premium: | $0.00 |
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Part D (Drug) Premium: | $16.70 |
Part D Supplemental Premium | $0.00 |
Total Part D Premium: | $16.70 |
Drug Deductible: | $360.00 |
Tiers with No Deductible: | 0 |
Benchmark: | below the regional benchmark |
Type of Medicare Health Plan: | Defined Standard Benefit |
Drug Benefit Type: | Basic |
Full LIS Premium: | $0.00 |
75% LIS Premium: | $4.20 |
50% LIS Premium: | $8.30 |
25% LIS Premium: | $12.50 |
Inital Coverage Limit: | $3310 |
Gap Coverage: | No |
Gap Coverage
In 2016 once you and your plan provider have spent $3,310 on covered drugs. (combined amount plus your deductible) You will be in the coverage gap. (AKA "donut hole") You will be required to pay 45% for brand-name drugs and 58% on generic drugs unless your plan offers additional coverage. This Care Improvement Plus plan does not offer additional coverage through the gap.
Ratings for Care Improvement Plus Dual Advantage (Regional PPO SNP) DS
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 Care Improvement Plus Dual Advantage (Regional PPO SNP) Plans Performance
Total Rating | ||
---|---|---|
Members Leaving the Plan | ||
Complaints about Health Plan | ||
Beneficiary Access | ||
Health Plan Quality Improvement |
Health Plan Customer Service Rating for Care Improvement Plus Dual Advantage (Regional PPO SNP)
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 |
Care Improvement Plus Dual Advantage (Regional PPO SNP) Drug Plan Customer Service ratings
Total Rating | ||
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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. All contracts for 2016 have not been 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
Includes 2016 approved contracts/plans. Employer sponsored 800 series plans and plans under sanction are excluded.