2019 Allwell Dual Medicare Essentials (HMO SNP) BA-H1436

Allwell Dual Medicare Essentials (HMO SNP) By Allwell



Allwell Dual Medicare Essentials (HMO SNP) is a 2019 Medicare Advantage Special Needs Plan plan by Allwell. This plan from Allwell 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 Allwell and not Original Medicare. All Medicare SNPs also provide Medicare additional Part-D drug coverage. Allwell Dual Medicare Essentials (HMO SNP) BA-H1436 is a Dual Eligible Special Needs Plan (D-SNP). A Dual Eligible SNP is for beneficiaries who are eligible for both Medicare and Medicaid. If you have Medicare and get help from Medicaid you can join any Medicare SNP you qualify for or switch plans at any time.



2019 Medicare Special Needs Plan Details

Plan Name:
Allwell Dual Medicare Essentials (HMO SNP)
Plan ID:
BA-H1436
Special Needs Type: Dual-Eligible
Provider: Allwell
Plan Year:2019
Plan Type: Local HMO
Monthly Premium C+D: $24.60


COMPARE AND SAVE ON MEDICARE INSURANCE




The Allwell Dual Medicare Essentials (HMO SNP) BA-H1436 is available to residents in South Carolina, and all Medicare SNPs must provide Medicare additional prescription drug (Part-D) coverage. Allwell Dual Medicare Essentials (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

Allwell 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 Allwell Dual Medicare Essentials (HMO SNP) plan has a monthly drug premium of $24.60 and a $225.00 drug deductible. This Allwell plan offers a $24.60 Part D Basic Premium that is 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 Allwell 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 $24.60. 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 Allwell Dual Medicare Essentials (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 $6.20 for 75% low income subsidy $12.30 for 50% and $18.50 for 25%.



Part C Premium: $0.00
Part D (Drug) Premium: $24.60
Part D Supplemental Premium $0.00
Total Part D Premium: $24.60
Drug Deductible: $225.00
Tiers with No Deductible: 1
Benchmark: below the regional benchmark
Type of Medicare Health Plan: Basic Alternative
Drug Benefit Type: Basic
Full LIS Premium: $0.00
75% LIS Premium: $6.20
50% LIS Premium: $12.30
25% LIS Premium: $18.50
Initial Coverage Limit:$3820
Gap Coverage: No


Gap Coverage

In 2019 once you and your plan provider have spent $3,820 on covered drugs. (combined amount plus your deductible) You will be in the coverage gap. (AKA "donut hole") You will be required to pay 25% for brand-name drugs and 37% on generic drugs unless your plan offers additional coverage. This Allwell plan does not offer additional coverage through the gap.





Plan Services




Health plan deductible


$0



Emergency care/Urgent care


Emergency $0 or $90 per visit (always covered)
Urgent care $0 or $20 per visit (always covered)



Diagnostic procedures/lab services/imaging


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



Hearing


Hearing exam $0 or $20
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 $0 copay
Periodontics $0 copay
Extractions $0 copay
Prosthodontics, other oral/maxillofacial surgery, other services $0 copay



Vision


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



Mental health services


Inpatient hospital - psychiatric $0 or $400 per day for days 1 through 4
$0 per day for days 5 through 90
Outpatient group therapy visit with a psychiatrist $0 or $20
Outpatient individual therapy visit with a psychiatrist $0 or $20
Outpatient group therapy visit $0 or $20
Outpatient individual therapy visit $0 or $20



Skilled Nursing Facility


$0 per day for days 1 through 20
$0 or $170 per day for days 21 through 100



Rehabilitation services


Occupational therapy visit $0 or $20
Physical therapy and speech and language therapy visit $0 or $20



Ground ambulance


$0 or $250



Other health plan deductibles?


In-Network No



Transportation


Not covered



Foot care (podiatry services)


Foot exams and treatment $0 or $20
Routine foot care $0 copay



Medical equipment/supplies


Durable medical equipment (e.g., wheelchairs, oxygen) 0% or 20% per item
Prosthetics (e.g., braces, artificial limbs) 0% or 20% per item
Diabetes supplies 0% or 20% per item



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


Covered



Medicare Part B drugs


Chemotherapy 0% or 20%
Other Part B drugs 0% or 20%



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


$6,700 In-network



Optional supplemental benefits


No



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


In-Network No



Inpatient hospital coverage


$0 or $450 per day for days 1 through 4
$0 per day for days 5 through 90



Outpatient hospital coverage


$0 or $200 per visit



Doctor visits


Primary $0 copay
Specialist $0 or $20 per visit



Preventive care


$0 copay





Coverage Area for Allwell Dual Medicare Essentials (HMO SNP)



Source: CMS.

Plans as of September 2, 2018.

Star Rating as of October 10, 2018.

Notes: Data are subject to change. All contracts for 2019 have not been finalized. For 2019, 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 2019 approved contracts/plans. Employer sponsored 800 series plans and plans under sanction are excluded.

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