2018 Freedom VIP Savings (HMO SNP) EA-H5427

Freedom VIP Savings (HMO SNP) By Freedom Health, Inc.



Freedom VIP Savings (HMO SNP) is a 2018 Medicare Advantage Special Needs Plan plan by Freedom Health, Inc.. This plan from Freedom Health, Inc. 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 Freedom Health, Inc. and not Original Medicare. All Medicare SNPs also provide Medicare additional Part-D drug coverage. Freedom VIP Savings (HMO SNP) EA-H5427 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:
Freedom VIP Savings (HMO SNP)
Plan ID:
EA-H5427
Special Needs Type: Chronic or Disabling Condition
Provider: Freedom Health, Inc.
Plan Year:2018
Plan Type: Local HMO
Monthly Premium C+D: $0.00


COMPARE AND SAVE ON MEDICARE INSURANCE




Coverage Area for Freedom VIP Savings (HMO SNP)



The Freedom VIP Savings (HMO SNP) EA-H5427 is available to residents in Florida, and all Medicare SNPs must provide Medicare additional prescription drug (Part-D) coverage. Freedom VIP Savings (HMO SNP) 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.

Part-C Premium

Freedom Health, Inc. 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 Freedom VIP Savings (HMO SNP) plan has a monthly drug premium of $0.00 and a $0.00 drug deductible. This Freedom Health, Inc. plan offers a $0.00 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 Freedom Health, Inc. 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 $0.00. 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 Freedom VIP Savings (HMO SNP) medicare insurance plan offers a $0.00 premium obligation if you receive a full low-income subsidy (LIS) assistance. And the payment is $0.00 for 75% low income subsidy $0.00 for 50% and $0.00 for 25%.



Part C Premium: $0.00
Part D (Drug) Premium: $0.00
Part D Supplemental Premium $0.00
Total Part D Premium: $0.00
Drug Deductible: $0.00
Tiers with No Deductible: 0
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: $0.00
50% LIS Premium: $0.00
25% LIS Premium: $0.00
Initial Coverage Limit:$3750
Gap Coverage: Yes


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 Freedom Health, Inc. plan does offer additional coverage through the gap.



Plan Services






Health plan deductible


$0



Diagnostic procedures/lab services/imaging


Diagnostic tests and procedures $0-250 or 20%
Lab services $0-50
Diagnostic radiology services (e.g., MRI) $25-250
Outpatient x-rays $0-250



Hearing


Hearing exam $0 copay
Fitting/evaluation $0 copay
Hearing aids $0 copay



Preventive dental


Oral exam $0 copay
Cleaning $0 copay
Fluoride treatment $0 copay
Dental x-ray(s) $0 copay



Comprehensive dental


Non-routine services Not covered
Diagnostic services Not covered
Restorative services $0 copay
Endodontics Not covered
Periodontics Not covered
Extractions $0 copay
Prosthodontics, other oral/maxillofacial surgery, other services Not covered



Vision


Routine eye exam $0 copay
Other Not covered
Contact lenses $10
Eyeglasses (frames and lenses) $10
Eyeglass frames Not covered
Eyeglass lenses Not covered
Upgrades $30



Mental health services


$195 for days 1 through 7
$0 for days 8 through 90
Outpatient group therapy visit with a psychiatrist $30
Outpatient individual therapy visit with a psychiatrist $30
Outpatient group therapy visit $30
Outpatient individual therapy visit $30



Skilled Nursing Facility


$0 for days 1 through 5
$20 for days 6 through 20
$150 for days 21 through 100



Rehabilitation services


Occupational therapy visit $30
Physical therapy and speech and language therapy visit $30



Ambulance


$175



Transportation


$0 copay



Other health plan deductibles?


In-Network No



Foot care (podiatry services)


Foot exams and treatment $30
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 $0 copay



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


Covered



Medicare Part B drugs


Chemotherapy 20%
Other Part B drugs 20%



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


$3,400 In-network



Optional supplemental benefits


No



Inpatient hospital coverage


$195 for days 1 through 7
$0 for days 8 through 90



Outpatient hospital coverage


$250 per visit



Doctor visits


Primary $0 copay
Specialist $30 per visit



Preventive care


$0 copay



Emergency care/Urgent care


Emergency $75 per visit (always covered)
Urgent care $10 per visit (always covered)




Ratings for Freedom VIP Savings (HMO 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 Freedom VIP Savings (HMO 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 Freedom VIP Savings (HMO 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


Freedom VIP Savings (HMO 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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