2018 AR Blue Cross - Medi-Pak Advantage MA (PFFS) H4213-016 By ARKANSAS BLUE CROSS AND BLUE SHIELD

2018 Medicare Advantage AR Blue Cross - Medi-Pak Advantage MA (PFFS)

AR Blue Cross - Medi-Pak Advantage MA (PFFS) H4213-016 is a 2018 Medicare Advantage or Medicare Part-C plan by ARKANSAS BLUE CROSS AND BLUE SHIELD available to residents in Arkansas. This plan does not provide additional Medicare prescription drug (Part-D) coverage. The AR Blue Cross - Medi-Pak Advantage MA (PFFS) has a monthly premium of $25.00 and has a in-network Maximum Out-of-Pocket limit of N/A (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 N/A this can be a very nice safety net.

AR Blue Cross - Medi-Pak Advantage MA (PFFS) is a PFFS *. A Private Fee-For-Service (PFFS) plan is a Medicare Advantage (MA) health plan offered by a contract with the Centers for Medicare & Medicaid Services (CMS) to provide you with benefits. ARKANSAS BLUE CROSS AND BLUE SHIELD (instead of Medicare) will decide on how much it will cover and how much you will pay for the services you get. You may go to any Medicare approved doctor or hospital or any other health care provider that accepts both Medicare and your plans payment. A PFFS plan has no provider network, and you dont need a referral or a primary care physician for any health care or services. PFFS plans are the most flexible but a doctor will make a visit-by-visit decisions on whether to accept your provider.

ARKANSAS BLUE CROSS AND BLUE SHIELD works with Medicare to give you significant coverage beyond Part A and Part B benefits. If you decide to sign up for AR Blue Cross - Medi-Pak Advantage MA (PFFS) you still retain Original Medicare. But you will get additional Part A (Hospital Insurance) and Part B (Medical Insurance) coverage from ARKANSAS BLUE CROSS AND BLUE SHIELD 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 ARKANSAS BLUE CROSS AND BLUE SHIELD 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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2018 ARKANSAS BLUE CROSS AND BLUE SHIELD Medicare Advantage Plan Details

Name:
AR Blue Cross - Medi-Pak Advantage MA (PFFS)
ID:
H4213-016
Provider:ARKANSAS BLUE CROSS AND BLUE SHIELD
Year:2018
Type: PFFS *
Monthly Premium C+D: $25.00
MOOP: N/A




Plan Services






Health plan deductible


$500 Out-of-network



Diagnostic procedures/lab services/imaging


Diagnostic tests and procedures In-Network 20%
Diagnostic tests and procedures Out-of-Network 20-40%
Lab services In-Network $0 copay
Lab services Out-of-Network 0-40%
Diagnostic radiology services (e.g., MRI) In-Network $315
Diagnostic radiology services (e.g., MRI) Out-of-Network $315 or 40%
Outpatient x-rays In-Network 20%
Outpatient x-rays Out-of-Network 20-40%



Hearing


Hearing exam In-Network $50
Hearing exam Out-of-Network $50 or 40%
Fitting/evaluation Not covered
Hearing aids - inner ear Not covered
Hearing aids - outer ear Not covered
Hearing aids - over the ear Not covered



Preventive dental


Oral exam Not covered
Cleaning Not covered
Fluoride treatment Not covered
Dental x-ray(s) Not covered



Comprehensive dental


Non-routine services Not covered
Diagnostic services Not covered
Restorative services Not covered
Endodontics Not covered
Periodontics Not covered
Extractions Not covered
Prosthodontics, other oral/maxillofacial surgery, other services Not covered



Vision


Routine eye exam Not covered
Other Not covered
Contact lenses Not covered
Eyeglasses (frames and lenses) Not covered
Eyeglass frames Not covered
Eyeglass lenses Not covered
Upgrades Not covered



Mental health services


In-Network $295 for days 1 through 5
$0 for days 6 through 90
Out-of-Network 40% per stay
$295 for days 1 through 5
$0 for days 6 through 90
Outpatient group therapy visit with a psychiatrist In-Network $40
Outpatient group therapy visit with a psychiatrist Out-of-Network $40 or 40%
Outpatient individual therapy visit with a psychiatrist In-Network $40
Outpatient individual therapy visit with a psychiatrist Out-of-Network $40 or 40%
Outpatient group therapy visit In-Network $40
Outpatient group therapy visit Out-of-Network $40 or 40%
Outpatient individual therapy visit In-Network $40
Outpatient individual therapy visit Out-of-Network $40 or 40%



Skilled Nursing Facility


In-Network $0 for days 1 through 20
$167.50 for days 21 through 100
Out-of-Network 40% per stay
$0 for days 1 through 20
$167.50 for days 21 through 100



Rehabilitation services


Occupational therapy visit In-Network $40
Occupational therapy visit Out-of-Network $40 or 40%
Physical therapy and speech and language therapy visit In-Network $40
Physical therapy and speech and language therapy visit Out-of-Network $40 or 40%



Ambulance


In-Network $350
Out-of-Network $350



Transportation


Not covered



Other health plan deductibles?


In-Network No



Foot care (podiatry services)


Foot exams and treatment In-Network $50-315
Foot exams and treatment Out-of-Network $50-315 or 40%
Routine foot care Not covered



Medical equipment/supplies


Durable medical equipment (e.g., wheelchairs, oxygen) In-Network 20% per item
Durable medical equipment (e.g., wheelchairs, oxygen) Out-of-Network 20-40% per item
Prosthetics (e.g., braces, artificial limbs) In-Network 20% per item
Prosthetics (e.g., braces, artificial limbs) Out-of-Network 20-40% per item
Diabetes supplies In-Network 20% per item
Diabetes supplies Out-of-Network 20-40% per item



Wellness programs (e.g., fitness, nursing hotline)


Covered



Medicare Part B drugs


Chemotherapy In-Network 20%
Chemotherapy Out-of-Network 20-40%
Other Part B drugs In-Network 20%
Other Part B drugs Out-of-Network 20-40%



Maximum out-of-pocket enrollee responsibility (does not include prescription drugs)


$6,700 In and Out-of-network



Optional supplemental benefits


No



Inpatient hospital coverage


In-Network $350 for days 1 through 5
$0 for days 6 through 90
Out-of-Network 40% per stay
$350 for days 1 through 5
$0 for days 6 through 90



Outpatient hospital coverage


In-Network $315 per visit
Out-of-Network $315 or 40% per visit



Doctor visits


Primary In-Network $20 per visit
Primary Out-of-Network $20 or 40% per visit
Specialist In-Network $50 per visit
Specialist Out-of-Network $50 or 40% per visit



Preventive care


In-Network $0 copay
Out-of-Network 0-40%



Emergency care/Urgent care


Emergency $80 per visit (always covered)
Urgent care $35 per visit (always covered)






Ratings for AR Blue Cross - Medi-Pak Advantage MA (PFFS) H4213

2018 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 AR Blue Cross - Medi-Pak Advantage MA (PFFS) Plans Performance

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


Health Plan Customer Service Rating for AR Blue Cross - Medi-Pak Advantage MA (PFFS)

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 Cancer 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
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


AR Blue Cross - Medi-Pak Advantage MA (PFFS) Drug Plan Customer Service ratings

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


Coverage Area for AR Blue Cross - Medi-Pak Advantage MA (PFFS)

(Click county to compare all available plans)



Source: CMS.

Data as of September 5, 2017

Star Rating as of September 6, 2017.

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

Notes: Data are subject to change as contracts are finalized. For 2018, 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 2018 approved contracts. Employer sponsored 800 series and plans under sanction are excluded.

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