2019 Select (HMO-POS SNP) EA-H1587

Select (HMO-POS SNP) By Superior Select Health Plans



Select (HMO-POS SNP) is a 2019 Medicare Advantage Special Needs Plan plan by Superior Select Health Plans. This plan from Superior Select Health Plans 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 Superior Select Health Plans and not Original Medicare. All Medicare SNPs also provide Medicare additional Part-D drug coverage. Select (HMO-POS SNP) EA-H1587 is an Institutional SNP (I-SNP). An Institutional SNP is for beneficiaries who live in an institution such as a nursing home or require nursing care at home. If you live in an institution like a nursing home or hospital you can join any Medicare SNP you qualify for or switch plans at any time.



2019 Medicare Special Needs Plan Details

Plan Name:
Select (HMO-POS SNP)
Plan ID:
EA-H1587
Special Needs Type: Institutional
Provider: Superior Select Health Plans
Plan Year:2019
Plan Type: Local HMO
Monthly Premium C+D: $65.00


COMPARE AND SAVE ON MEDICARE INSURANCE




The Select (HMO-POS SNP) EA-H1587 is available to residents in Arkansas, and all Medicare SNPs must provide Medicare additional prescription drug (Part-D) coverage. Select (HMO-POS 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

Superior Select Health Plans plan charges a $5.00 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 Select (HMO-POS SNP) plan has a monthly drug premium of $60.00 and a $0.00 drug deductible. This Superior Select Health Plans plan offers a $60.00 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 Superior Select Health Plans 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 $60.00. 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 Select (HMO-POS SNP) medicare insurance plan offers a $35.20 premium obligation if you receive a full low-income subsidy (LIS) assistance. And the payment is $41.40 for 75% low income subsidy $47.60 for 50% and $53.80 for 25%.



Part C Premium: $5.00
Part D (Drug) Premium: $60.00
Part D Supplemental Premium $0.00
Total Part D Premium: $60.00
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: $35.20
75% LIS Premium: $41.40
50% LIS Premium: $47.60
25% LIS Premium: $53.80
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 Superior Select Health Plans plan does not offer additional coverage through the gap.





Plan Services




Health plan deductible


$0



Emergency care/Urgent care


Emergency $80 per visit (always covered)
Urgent care $35 per visit (always covered)



Diagnostic procedures/lab services/imaging


Diagnostic tests and procedures In-Network 20%
Lab services In-Network $0 copay
Diagnostic radiology services (e.g., MRI) In-Network $110-220
Outpatient x-rays In-Network 0%



Hearing


Hearing exam In-Network 20%
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 In-Network $0 copay
Routine eye exam Out-of-Network $0 copay
Other Not covered
Contact lenses Not covered
Eyeglasses (frames and lenses) In-Network $0 copay
Eyeglasses (frames and lenses) Out-of-Network $0 copay
Eyeglass frames In-Network $0 copay
Eyeglass frames Out-of-Network $0 copay
Eyeglass lenses In-Network $0 copay
Eyeglass lenses Out-of-Network $0 copay
Upgrades Not covered



Mental health services


Inpatient hospital - psychiatric In-Network $300 per day for days 1 through 5
$0 per day for days 6 through 90
Inpatient hospital - psychiatric Out-of-Network Not Applicable
Outpatient group therapy visit with a psychiatrist In-Network 20%
Outpatient individual therapy visit with a psychiatrist In-Network 20%
Outpatient group therapy visit In-Network 20%
Outpatient individual therapy visit In-Network 20%



Skilled Nursing Facility


In-Network Coming soon
Out-of-Network Not Applicable



Rehabilitation services


Occupational therapy visit In-Network 10%
Physical therapy and speech and language therapy visit In-Network 10%



Ground ambulance


In-Network $150



Other health plan deductibles?


In-Network No



Transportation


Not covered



Foot care (podiatry services)


Foot exams and treatment In-Network $35
Routine foot care Not covered



Medical equipment/supplies


Durable medical equipment (e.g., wheelchairs, oxygen) In-Network 10% per item
Prosthetics (e.g., braces, artificial limbs) In-Network 20% per item
Diabetes supplies In-Network $0 copay



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


Covered



Medicare Part B drugs


Chemotherapy In-Network 20%
Other Part B drugs In-Network 20%



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


$3,500 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


In-Network $300 per day for days 1 through 5
$0 per day for days 6 through 90
Out-of-Network Not Applicable



Outpatient hospital coverage


In-Network 20% per visit



Doctor visits


Primary In-Network $0 copay
Specialist In-Network $35 per visit



Preventive care


In-Network $0 copay





Coverage Area for Select (HMO-POS 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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