2018 SeniorCare Preferred - Basic Rx (Cost) H4564-002 By Baylor Scott & White Health Plan

2018 Medicare Advantage SeniorCare Preferred - Basic Rx (Cost)

SeniorCare Preferred - Basic Rx (Cost) H4564-002 is a 2018 Medicare Advantage or Medicare Part-C plan by Baylor Scott & White Health Plan available to residents in Texas. This plan includes additional Medicare prescription drug (Part-D) coverage. The SeniorCare Preferred - Basic Rx (Cost) has a monthly premium of $166.50 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.

SeniorCare Preferred - Basic Rx (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.

Baylor Scott & White Health Plan works with Medicare to give you significant coverage beyond Part A and Part B benefits. If you decide to sign up for SeniorCare Preferred - Basic Rx (Cost) you still retain Original Medicare. But you will get additional Part A (Hospital Insurance) and Part B (Medical Insurance) coverage from Baylor Scott & White Health Plan 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 Baylor Scott & White Health Plan 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 Baylor Scott & White Health Plan Medicare Advantage Plan Details

Name:
SeniorCare Preferred - Basic Rx (Cost)
ID:
H4564-002
Provider:Baylor Scott & White Health Plan
Year:2018
Type: Cost
Monthly Premium C+D: $166.50
MOOP: $3,400




Plan Services






Health plan deductible


$0



Diagnostic procedures/lab services/imaging


Diagnostic tests and procedures $15
Lab services $15
Diagnostic radiology services (e.g., MRI) $0-15
Outpatient x-rays $15



Hearing


Hearing exam $15
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 $0 copay
Other Not covered
Contact lenses $0 copay
Eyeglasses (frames and lenses) $0 copay
Eyeglass frames $0 copay
Eyeglass lenses $0 copay
Upgrades Not covered



Mental health services


$450 per stay
Outpatient group therapy visit with a psychiatrist $15
Outpatient individual therapy visit with a psychiatrist $15
Outpatient group therapy visit $15
Outpatient individual therapy visit $15



Skilled Nursing Facility


$0 for days 1 through 20
$35 for days 21 through 100



Rehabilitation services


Occupational therapy visit $15
Physical therapy and speech and language therapy visit $15



Ambulance


$75



Transportation


Not covered



Other health plan deductibles?


In-Network No



Foot care (podiatry services)


Foot exams and treatment $15
Routine foot care Not covered



Medical equipment/supplies


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



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


Covered



Medicare Part B drugs


Chemotherapy $0 copay
Other Part B drugs $0 copay



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


$3,400 In-network



Optional supplemental benefits


Yes



Inpatient hospital coverage


$450 per stay



Outpatient hospital coverage


$15 per visit



Doctor visits


Primary $15 per visit
Specialist $15 per visit



Preventive care


$0 copay



Emergency care/Urgent care


Emergency $200 per visit (always covered)
Urgent care $40 per visit (always covered)






Ratings for SeniorCare Preferred - Basic Rx (Cost) H4564

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 SeniorCare Preferred - Basic Rx (Cost) Plans Performance

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


Health Plan Customer Service Rating for SeniorCare Preferred - Basic Rx (Cost)

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


SeniorCare Preferred - Basic Rx (Cost) Drug Plan Customer Service ratings

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


Part-C Premium

Baylor Scott & White Health Plan plan charges a 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

SeniorCare Preferred - Basic Rx (Cost) has a monthly drug premium of $63.10 and a $100.00 drug deductible. This Baylor Scott & White Health Plan plan offers a $63.10 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 $13.40 this Premium covers any enhanced plan benefits offered by Baylor Scott & White Health Plan 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 $76.50. 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 SeniorCare Preferred - Basic Rx (Cost) medicare insurance offers a $51.90 premium obligation if you receive a full low-income subsidy (LIS) assistance. And the payment is $58.10 for 75% low income subsidy $64.20 for 50% and $70.40 for 25%.



Part C Premium:
Part D (Drug) Premium: $63.10
Part D Supplemental Premium $13.40
Total Part D Premium: $76.50
Drug Deductible: $100.00
Tiers with No Deductible: 1
Benchmark: not below the regional benchmark
Type of Medicare Health: Enhanced Alternative
Drug Benefit Type: Enhanced
Full LIS Premium: $51.90
75% LIS Premium: $58.10
50% LIS Premium: $64.20
25% LIS Premium: $70.40
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 Baylor Scott & White Health Plan plan does not offer additional coverage through the gap.



Coverage Area for SeniorCare Preferred - Basic Rx (Cost)

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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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