2018 EON GOLD (PPO SNP) EA-H9589

EON GOLD (PPO SNP) By Eon Health

EON GOLD (PPO SNP) is a 2018 Medicare Advantage Special Needs Plan plan by Eon Health. This plan from Eon Health works with Medicare to give you significant coverage beyond original Medicare. If you decide to sign up you still retain Original Medicare. But you will get additional Part A (Hospital Insurance) and Part B (Medical Insurance) coverage from Eon Health and not Original Medicare. All Medicare SNPs also provide Medicare additional Part-D drug coverage. EON GOLD (PPO SNP) EA-H9589 is a Chronic Condition SNP (C-SNP). A Chronic Condition SNP is for beneficiaries with the following severe or disabling chronic conditions: . If you have Medicare and you develop certain severe or disabling conditions you can join a Medicare SNP designed to serve people with those conditions at any time.

2018 Medicare Special Needs Plan Details

Plan Name:
Plan ID:
Special Needs Type: Chronic or Disabling Condition
Provider: Eon Health
Plan Year:2018
Plan Type: Local PPO
Monthly Premium C+D: $15.00


Coverage Area for EON GOLD (PPO SNP)

The EON GOLD (PPO SNP) EA-H9589 is available to residents in Georgia, and all Medicare SNPs must provide Medicare additional prescription drug (Part-D) coverage. EON GOLD (PPO SNP) is a Local PPO. A preferred provider organization (PPO) is a medicare plan that has created contracts with a network of "preferred" providers for you to choose from at reduced rates. You do not need to select a primary care physician and you do not need referrals to see other providers in the network. Offering you a little more flexibility overall. You can get medical attention from a provider outside of the network but you will have to pay the difference between the out-of-network bill and the PPOs discounted rate.

Part-C Premium

Eon Health 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

The EON GOLD (PPO SNP) plan has a monthly drug premium of $15.00 and a $250.00 drug deductible. This Eon Health plan offers a $15.00 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 Eon Health 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 $15.00. 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 EON GOLD (PPO SNP) medicare insurance plan offers a $0.00 premium obligation if you receive a full low-income subsidy (LIS) assistance. And the payment is $3.70 for 75% low income subsidy $7.50 for 50% and $11.20 for 25%.

Part C Premium: $0.00
Part D (Drug) Premium: $15.00
Part D Supplemental Premium $0.00
Total Part D Premium: $15.00
Drug Deductible: $250.00
Tiers with No Deductible: 1
Benchmark: not below the regional benchmark
Type of Medicare Health Plan: Enhanced Alternative
Drug Benefit Type: Enhanced
Full LIS Premium: $0.00
75% LIS Premium: $3.70
50% LIS Premium: $7.50
25% LIS Premium: $11.20
Initial Coverage Limit:$3750
Gap Coverage: No

Gap Coverage

In 2018 once you and your plan provider have spent $3,750 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 Eon Health plan does not offer additional coverage through the gap.

Plan Services

Health plan deductible

$500 annual deductible

Diagnostic procedures/lab services/imaging

Diagnostic tests and procedures In-Network 20%
Diagnostic tests and procedures Out-of-Network 40%
Lab services In-Network $5
Lab services Out-of-Network 40%
Diagnostic radiology services (e.g., MRI) In-Network 20%
Diagnostic radiology services (e.g., MRI) Out-of-Network 40%
Outpatient x-rays In-Network $25
Outpatient x-rays Out-of-Network 40%


Hearing exam In-Network $25
Hearing exam Out-of-Network 40%
Fitting/evaluation In-Network $0 copay
Fitting/evaluation Out-of-Network 50%
Hearing aids In-Network $0 copay
Hearing aids Out-of-Network 50%

Preventive dental

Oral exam In-Network $0 copay
Oral exam Out-of-Network 50%
Cleaning In-Network $0 copay
Cleaning Out-of-Network 50%
Fluoride treatment Not covered
Dental x-ray(s) In-Network $0 copay
Dental x-ray(s) Out-of-Network 50%

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


Routine eye exam In-Network $0 copay
Routine eye exam Out-of-Network 50%
Other Not covered
Contact lenses In-Network $0 copay
Contact lenses Out-of-Network 50%
Eyeglasses (frames and lenses) In-Network $0 copay
Eyeglasses (frames and lenses) Out-of-Network 50%
Eyeglass frames Not covered
Eyeglass lenses Not covered
Upgrades Not covered

Mental health services

In-Network $300 for days 1 through 5
$0 for days 6 through 90
Out-of-Network 40% per stay
Outpatient group therapy visit with a psychiatrist In-Network $40
Outpatient group therapy visit with a psychiatrist Out-of-Network 40%
Outpatient individual therapy visit with a psychiatrist In-Network $40
Outpatient individual therapy visit with a psychiatrist Out-of-Network 40%
Outpatient group therapy visit In-Network $40
Outpatient group therapy visit Out-of-Network 40%
Outpatient individual therapy visit In-Network $40
Outpatient individual therapy visit Out-of-Network 40%

Skilled Nursing Facility

In-Network $0 for days 1 through 20
$167 for days 21 through 100
Out-of-Network 40% per stay

Rehabilitation services

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


In-Network $225
Out-of-Network $225


Not covered

Other health plan deductibles?

In-Network No

Foot care (podiatry services)

Foot exams and treatment In-Network $0 copay
Foot exams and treatment Out-of-Network 40%
Routine foot care In-Network $0 copay
Routine foot care Out-of-Network 40%

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 40% per item
Prosthetics (e.g., braces, artificial limbs) In-Network 20% per item
Prosthetics (e.g., braces, artificial limbs) Out-of-Network 40% per item
Diabetes supplies In-Network $0 copay
Diabetes supplies Out-of-Network 40% per item

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


Medicare Part B drugs

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

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

$10,000 In and Out-of-network
$6,700 In-network
$10,000 Out-of-network

Optional supplemental benefits


Inpatient hospital coverage

In-Network $300 for days 1 through 5
$0 for days 6 through 90
Out-of-Network 40% per stay

Outpatient hospital coverage

In-Network $225 per visit
Out-of-Network 40% per visit

Doctor visits

Primary In-Network $15 per visit
Primary Out-of-Network 40% per visit
Specialist In-Network $50 per visit
Specialist Out-of-Network 40% per visit

Preventive care

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

Emergency care/Urgent care

Emergency $80 per visit (always covered)
Urgent care $50 per visit (always covered)

Ratings for EON GOLD (PPO SNP) EA

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 EON GOLD (PPO SNP) Plans Performance

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

Health Plan Customer Service Rating for EON GOLD (PPO SNP)

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

EON GOLD (PPO SNP) Drug Plan Customer Service ratings

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

Source: CMS.

Plans 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. All contracts for 2018 have not been finalized. For 2018, enhanced alternative plans may offer additional cost sharing reductions in the gap on a sub-set of the formulary drugs, beyond the standard Part Part D benefit.

Includes 2018 approved contracts/plans. Employer sponsored 800 series plans and plans under sanction are excluded.

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