2023 Medical Associates Community Plan (Cost)

Medical Associates Community Plan (Cost) H1651-004 is a 2023 Medicare Advantage Plan or Part-C by Medical Associates Health Plan, Inc. available to residents in Iowa. This plan does not provide extra prescription drug (Part-D) coverage. Medical Associates Health Plan, Inc. Medical Associates Community Plan (Cost) has a monthly premium of $150.00 and has an in-network maximum out-of-pocket limit of $- (MOOP). This means that if you get sick or need a high-cost procedure the co-pays are capped once you pay $- out-of-pocket. This can be an extremely nice safety net.

Medical Associates Health Plan, Inc. works with Medicare to provide significant coverage beyond Part A and Part B benefits. If you decide to sign up for Medical Associates Community Plan (Cost) you still retain Original Medicare. But you will get extra Part A (Hospital Insurance) and Part B (Medical Insurance) coverage from Medical Associates Health Plan, Inc. and not Original Medicare. With 2023 Medicare Advantage Plan you are always covered for urgently needed and emergency care. Plus, you receive all the benefits of Original Medicare from Medical Associates Health Plan, Inc. except hospice care. Original Medicare still provides you with hospice care if you sign up for Medicare Advantage in Iowa.



2023 Medical Associates Health Plan, Inc. Medicare Advantage Plan Overview

Name:Medical Associates Community Plan (Cost)
Plan ID:H1651 004 0
Provider:Medical Associates Health Plan, Inc.
Year:2023
Type:Cost *
Combined Premium (C+D):$150.00/mo
MOOP:$-/yr
Similar Plan: H1651-005




What type of plan is Medical Associates Community Plan (Cost)

Medical Associates Community 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.

How much does Medical Associates Community Plan (Cost) cost?


Part-C Premium

A monthly premium is the fee you pay to the plan in exchange for coverage. Medical Associates Health Plan, Inc. charges a $150.00 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.




2023 Summary of Benefits


The benefit information provided is a summary of what Medical Associates Community Plan (Cost) covers and what you pay (such as copayments and coinsurance amounts) for certain common medical events. The Summary of Benefits from Medical Associates Health Plan, Inc. helps get an idea of how much financial protection the plan is generally expected to provide for common health conditions. This section also contains information on coverage for in-network and out-of-network providers.

Wellness programs (e.g., fitness, nursing hotline)Not covered



Contact lenses


VisionNot covered



Eyeglass frames


VisionNot covered



Eyeglass lenses


VisionNot covered



Eyeglasses (frames and lenses)


VisionNot covered



Other


VisionNot covered



Routine eye exam


Vision$0 copay



Upgrades


VisionNot covered




TransportationNot covered
Skilled Nursing Facility$0 copay



Occupational therapy visit


Rehabilitation services$0 copay



Physical therapy and speech and language therapy visit


Rehabilitation services$0 copay



Cleaning


Preventive dentalNot covered



Dental x-ray(s)


Preventive dentalNot covered



Fluoride treatment


Preventive dentalNot covered



Oral exam


Preventive dentalNot covered




Preventive care$0 copay
Outpatient hospital coverage$0 copay
In-Network Other health plan deductibles?Yes
Optional supplemental benefitsNo



Inpatient hospital - psychiatric


Mental health services$0 copay



Outpatient group therapy visit


Mental health services$0 copay



Outpatient group therapy visit with a psychiatrist


Mental health services$0 copay



Outpatient individual therapy visit


Mental health services$0 copay



Outpatient individual therapy visit with a psychiatrist


Mental health services$0 copay



Diabetes supplies


Medical equipment/supplies$0 copay



Durable medical equipment (e.g., wheelchairs, oxygen)


Medical equipment/supplies$0 copay



Prosthetics (e.g., braces, artificial limbs)


Medical equipment/supplies$0 copay




Maximum out-of-pocket enrollee responsibility (does not include prescription drugs)Not Applicable
Inpatient hospital coverage$0 copay



Fitting/evaluation


HearingNot covered



Hearing aids - inner ear


HearingNot covered



Hearing aids - outer ear


HearingNot covered



Hearing aids - over the ear


HearingNot covered



Hearing exam


Hearing$0 copay




Health plan deductible$0
Ground ambulance$0 copay



Foot exams and treatment


Foot care (podiatry services)$0 copay



Routine foot care


Foot care (podiatry services)$0 copay



Emergency


Emergency care/Urgent care$0 copay



Urgent care


Emergency care/Urgent care$0 copay



Primary


Doctor visits$0 copay



Specialist


Doctor visits$0 copay



Diagnostic radiology services (e.g., MRI)


Diagnostic procedures/lab services/imaging$0 copay



Diagnostic tests and procedures


Diagnostic procedures/lab services/imaging$0 copay



Lab services


Diagnostic procedures/lab services/imaging$0 copay



Outpatient x-rays


Diagnostic procedures/lab services/imaging$0 copay



Diagnostic services


Comprehensive dentalNot covered



Endodontics


Comprehensive dentalNot covered



Extractions


Comprehensive dentalNot covered



Non-routine services


Comprehensive dentalNot covered



Periodontics


Comprehensive dentalNot covered



Prosthodontics, other oral/maxillofacial surgery, other services


Comprehensive dentalNot covered



Restorative services


Comprehensive dentalNot covered




In-Network Additional benefits and/or reduced cost-sharing for enrollees with certain health conditions?No




Coverage Area

(Click county or state to compare all available Advantage plans)

The availability of Medicare Advantage Plans will vary according to your region. This is why the Coverage Area matters in terms of Medicare eligibility. You will always be eligible for Original Medicare, but eligibility for Medical Associates Community Plan (Cost) requires you to live in that plan’s service area. The service area is listed below:



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How much does Medical Associates Community Plan (Cost) cost?

Medical Associates Health Plan, Inc. charges a $150.00 monthly premium. A monthly premium is the fee you pay to the plan in exchange for coverage. The premium covers Medicare medical, hospital benefits and supplemental benefits if offered. You generally are also responsible for paying the Part B premium.

How much is Medical Associates Community Plan (Cost) MOOP?

The maximum out-of-pocket (MOOP) is a yearly limit on your out-of-pocket costs. Medical Associates Community Plan (Cost) by Medical Associates Health Plan, Inc. MOOP is $-. Once you spend $- you will pay nothing for Part A or Part B covered services.

What type of plan is Medical Associates Community Plan (Cost)?

Medical Associates Community Plan (Cost) is a Cost * plan. A Cost plan is operated by a (HMO) in accordance with a cost reimbursement contract. You may use the cost plans network of providers or receive their health care services through Original Medicare.



Source:CMS. Data as of Oct 1, 2022.

Last updated on

Notes: Data are subject to change as contracts are finalized. For 2023, enhanced alternative may offer extra cost sharing reductions in the gap on a sub-set of the formulary drugs, beyond the standard Part-D benefit. Includes 2023 approved contracts. Employer sponsored 800 series and plans under sanction are excluded.

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