2018 Horizons (HMO-POS) H1587-002 By Superior Select Health Plans

2018 Medicare Advantage Horizons (HMO-POS)

Horizons (HMO-POS) H1587-002 is a 2018 Medicare Advantage or Medicare Part-C plan by Superior Select Health Plans available to residents in Arkansas. This plan includes additional Medicare prescription drug (Part-D) coverage. The Horizons (HMO-POS) has a monthly premium of $22.60 and has a in-network Maximum Out-of-Pocket limit of $6,700 (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 $6,700 this can be a very nice safety net.

Horizons (HMO-POS) 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.

Superior Select Health Plans works with Medicare to give you significant coverage beyond Part A and Part B benefits. If you decide to sign up for Horizons (HMO-POS) you still retain Original Medicare. But you will get additional Part A (Hospital Insurance) and Part B (Medical Insurance) coverage from Superior Select Health 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 Superior Select Health Plans except hospice care. Original Medicare still provides you with hospice care even if you sign up for a Medicare Advantage Plan.


2018 Superior Select Health Plans Medicare Advantage Plan Details

Horizons (HMO-POS)
Provider:Superior Select Health Plans
Type: Local HMO
Monthly Premium C+D: $22.60
MOOP: $6,700

Plan Services

Health plan deductible


Diagnostic procedures/lab services/imaging

Diagnostic tests and procedures In-Network 20%
Lab services In-Network $0 copay
Diagnostic radiology services (e.g., MRI) In-Network $100
Outpatient x-rays In-Network 20%


Hearing exam In-Network $0 copay
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 In-Network $0 copay
Oral exam Out-of-Network $0 copay
Cleaning In-Network $0 copay
Cleaning Out-of-Network $0 copay
Fluoride treatment In-Network $0 copay
Fluoride treatment Out-of-Network $0 copay
Dental x-ray(s) In-Network $0 copay
Dental x-ray(s) Out-of-Network $0 copay

Comprehensive dental

Non-routine services In-Network $0 copay
Non-routine services Out-of-Network $0 copay
Diagnostic services In-Network $0 copay
Diagnostic services Out-of-Network $0 copay
Restorative services In-Network $0 copay
Restorative services Out-of-Network $0 copay
Endodontics In-Network $0 copay
Endodontics Out-of-Network $0 copay
Periodontics In-Network $0 copay
Periodontics Out-of-Network $0 copay
Extractions In-Network $0 copay
Extractions Out-of-Network $0 copay
Prosthodontics, other oral/maxillofacial surgery, other services In-Network $0 copay
Prosthodontics, other oral/maxillofacial surgery, other services Out-of-Network $0 copay


Routine eye exam In-Network $0 copay
Routine eye exam Out-of-Network $0 copay
Other Not covered
Contact lenses Not covered
Eyeglasses (frames and lenses) In-Network $0 copay
Eyeglasses (frames and lenses) Out-of-Network $0 copay
Eyeglass frames In-Network $0 copay
Eyeglass frames Out-of-Network $0 copay
Eyeglass lenses In-Network $0 copay
Eyeglass lenses Out-of-Network $0 copay
Upgrades Not covered

Mental health services

In-Network $230 for days 1 through 7
$0 for days 8 through 90
Out-of-Network Not Applicable
Outpatient group therapy visit with a psychiatrist In-Network $40
Outpatient individual therapy visit with a psychiatrist In-Network $40
Outpatient group therapy visit In-Network $40
Outpatient individual therapy visit In-Network $40

Skilled Nursing Facility

In-Network $0 for days 1 through 20
$160 for days 21 through 100
Out-of-Network Not Applicable

Rehabilitation services

Occupational therapy visit In-Network $40
Physical therapy and speech and language therapy visit In-Network $40


In-Network $250


In-Network $0 copay

Other health plan deductibles?

In-Network No

Foot care (podiatry services)

Foot exams and treatment In-Network $35
Routine foot care Not covered

Medical equipment/supplies

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

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

Not covered

Medicare Part B drugs

Chemotherapy In-Network 20%
Other Part B drugs In-Network 20%

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

$6,700 In-network

Optional supplemental benefits


Inpatient hospital coverage

In-Network $360 for days 1 through 5
$0 for days 6 through 90
Out-of-Network Not Applicable

Outpatient hospital coverage

In-Network 20% per visit

Doctor visits

Primary In-Network $0 copay
Specialist In-Network $50 per visit

Preventive care

In-Network $0 copay

Emergency care/Urgent care

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

Ratings for Horizons (HMO-POS) H1587

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 Horizons (HMO-POS) Plans Performance

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

Health Plan Customer Service Rating for Horizons (HMO-POS)

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

Horizons (HMO-POS) Drug Plan Customer Service ratings

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

Part-C Premium

Superior Select Health Plans 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

Horizons (HMO-POS) has a monthly drug premium of $22.60 and a $0.00 drug deductible. This Superior Select Health Plans plan offers a $22.60 Part D Basic Premium that is not 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 Superior Select Health Plans 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 $22.60. 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 Horizons (HMO-POS) medicare insurance offers a $0.00 premium obligation if you receive a full low-income subsidy (LIS) assistance. And the payment is $5.70 for 75% low income subsidy $11.30 for 50% and $17.00 for 25%.

Part C Premium: $0.00
Part D (Drug) Premium: $22.60
Part D Supplemental Premium $0.00
Total Part D Premium: $22.60
Drug Deductible: $0.00
Tiers with No Deductible: 0
Benchmark: not below the regional benchmark
Type of Medicare Health: Enhanced Alternative
Drug Benefit Type: Enhanced
Full LIS Premium: $0.00
75% LIS Premium: $5.70
50% LIS Premium: $11.30
25% LIS Premium: $17.00
Initial Coverage Limit:$3750
Gap Coverage: No

Gap Coverage

In 2018 once you and your plan provider have spent $3750 on covered drugs. (combined amount plus your deductible) You will be in the coverage gap. (AKA "donut hole") You will be required to pay 35% for brand-name drugs and 44% on generic drugs unless your plan offers additional coverage. This Superior Select Health Plans plan does not offer additional coverage through the gap.

Coverage Area for Horizons (HMO-POS)

(Click county to compare all available Advantage plans)

Source: CMS.

Data as of September 2, 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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