2019 Rocky Mountain Green Plan (Cost) H0602-042 By Rocky Mountain Health Plans

2019 Medicare Advantage Plan Services for
Rocky Mountain Green Plan (Cost)


Rocky Mountain Green Plan (Cost) H0602-042 is a 2019 Medicare Advantage or Medicare Part-C plan by Rocky Mountain Health Plans available to residents in Colorado. This plan does not provide additional Medicare prescription drug (Part-D) coverage. The Rocky Mountain Green Plan (Cost) has a monthly premium of $35.00 and has an in-network Maximum Out-of-Pocket limit of $6,700 (MOOP). This means that if you get sick or need a high cost procedure the co-pays are capped once you pay $6,700 out of pocket. This can be a extremely nice safety net.

Rocky Mountain Green Plan (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.

Rocky Mountain Health Plans works with Medicare to provide significant coverage beyond Part A and Part B benefits. If you decide to sign up for Rocky Mountain Green Plan (Cost) you still retain Original Medicare. But you will get additional Part A (Hospital Insurance) and Part B (Medical Insurance) coverage from Rocky Mountain Health Plans and not Original Medicare. With Medicare Advantage Plans you are always covered for urgently needed and emergency care. Plus you receive all of the benefits of Original Medicare from Rocky Mountain Health Plans 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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2019 Rocky Mountain Health Plans Medicare Advantage Plan Details

Name:
Rocky Mountain Green Plan (Cost)
ID:
H0602-042
Provider:Rocky Mountain Health Plans
Year:2019
Type: Cost *
Monthly Premium C+D: $35.00
Part C Premium:
MOOP: $6,700






Plan Services




Health plan deductible


$700 In-network



Emergency care/Urgent care


Emergency $125 per visit (always covered)
Urgent care $55 per visit (always covered)



Diagnostic procedures/lab services/imaging


Diagnostic tests and procedures $25-55 or 0-25%
Lab services $0
Diagnostic radiology services (e.g., MRI) 20%
Outpatient x-rays $55



Hearing


Hearing exam $25-55
Fitting/evaluation Not covered
Hearing aids $499-799



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 $55
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


Inpatient hospital - psychiatric $350 per day for days 1 through 10
$0 per day for days 11 through 90
Outpatient group therapy visit with a psychiatrist $55
Outpatient individual therapy visit with a psychiatrist $55
Outpatient group therapy visit $55
Outpatient individual therapy visit $55



Skilled Nursing Facility


$0 per day for days 1 through 20
$172 per day for days 21 through 100



Rehabilitation services


Occupational therapy visit $25
Physical therapy and speech and language therapy visit $25



Ground ambulance


$250



Other health plan deductibles?


In-Network No



Transportation


Not covered



Foot care (podiatry services)


Foot exams and treatment $55
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)


Not covered



Medicare Part B drugs


Chemotherapy Not Applicable
Other Part B drugs Not Applicable



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


$6,700 In-network



Optional supplemental benefits


Yes



Additional benefits and/or reduced cost-sharing for enrollees with certain health conditions?


In-Network No



Inpatient hospital coverage


$350 per day for days 1 through 10
$0 per day for days 11 through 90



Outpatient hospital coverage


25% per visit



Doctor visits


Primary $25 per visit
Specialist $55 per visit



Preventive care


$0 copay






Coverage Area for Rocky Mountain Green Plan (Cost)

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Source: CMS.
Data as of September 2, 2018.
Star Rating as of October 10, 2018.
For More Information on Ratings Please See the CMS Tech Notes.
Notes: Data are subject to change as contracts are finalized. For 2019, 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 2019 approved contracts. Employer sponsored 800 series and plans under sanction are excluded.

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