2017 Health New England Medicare Basic No Rx (HMO) H8578-009 By Health New England Medicare Advantage Plans

2017 Medicare Advantage Health New England Medicare Basic No Rx (HMO)

Health New England Medicare Basic No Rx (HMO) H8578-009 is a 2017 Medicare Advantage or Medicare Part-C plan by Health New England Medicare Advantage Plans available to residents in Massachusetts. This plan does not provide additional Medicare prescription drug (Part-D) coverage. The Health New England Medicare Basic No Rx (HMO) has a monthly premium of $38.00 and has a in-network Maximum Out-of-Pocket limit of $3,400 (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 $3,400 this can be a very nice safety net.

Health New England Medicare Basic No Rx (HMO) is a Local HMO *. With a health maintenance organization (HMO) you will be required to receive most of your health care from an in-network provider. Health maintenance organizations require that you select a primary care physician (PCP). Your PCP will serve as your personal doctor to provide all of your basic healthcare services. If you need special care for a physician specialist, your primary care physician will make the arrangements and tell you where you can go in the network. You will need your PCPs okay, called a referral. Without getting a referral or services received from out-of-network providers are not typically covered by the plan.

Health New England Medicare Advantage Plans works with Medicare to give you significant coverage beyond Part A and Part B benefits. If you decide to sign up for Health New England Medicare Basic No Rx (HMO) you still retain Original Medicare. But you will get additional Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance) coverage from Health New England Medicare Advantage Plans and not Original Medicare. With Medicare Advantage your always covered for urgently needed and emergency care and you receive all of the benefits of Original Medicare from Health New England Medicare Advantage Plans 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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2017 Health New England Medicare Advantage Plans Medicare Advantage Plan Details

Name:
Health New England Medicare Basic No Rx (HMO)
ID:
H8578-009
Provider:Health New England Medicare Advantage Plans
Year:2017
Type: Local HMO *
Monthly Premium C+D: $38.00
MOOP: $3,400




Ratings for Health New England Medicare Basic No Rx (HMO) H8578

2017 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 Health New England Medicare Basic No Rx (HMO) Plans Performance

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


Health Plan Customer Service Rating for Health New England Medicare Basic No Rx (HMO)

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


Health New England Medicare Basic No Rx (HMO) Drug Plan Customer Service ratings

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


Coverage Area for Health New England Medicare Basic No Rx (HMO)

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Source: CMS.

Data as of September 6, 2016

Star Rating as of September 26, 2016.

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

Notes: Data are subject to change as contracts are finalized. For 2017, enhanced alternative may offer additional cost sharing reductions in the gap on a sub-set of the formulary drugs, beyond the standard Part D benefit

Includes 2017 approved contracts. Employer sponsored 800 series and plans under sanction are excluded.

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