2020 Medicare Advantage Plan Services for
Rocky Mountain Plus Plan (Cost)
Rocky Mountain Plus Plan (Cost) H0602-003 is a 2020 Medicare Advantage Plan 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 Plus Plan (Cost) has a monthly premium of $189.00 and has an in-network Maximum Out-of-Pocket limit of $4,500 (MOOP). This means that if you get sick or need a high cost procedure the co-pays are capped once you pay $4,500 out of pocket. This can be a extremely nice safety net.
Rocky Mountain Plus 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 Plus 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.
2020 Rocky Mountain Health Plans Medicare Advantage Plan Details
Rocky Mountain Plus Plan (Cost)
|Provider:||Rocky Mountain Health Plans|
|Monthly Premium C+D:||$189.00|
|Part C Premium:|
2019 Plan Services
(*2020 Plan services will be added when available)
Health plan deductible
Emergency care/Urgent care
|Emergency||$50 per visit (always covered)|
|Urgent care||$40 per visit (always covered)|
Diagnostic procedures/lab services/imaging
|Diagnostic tests and procedures||$0-300|
|Lab services||$0 copay|
|Diagnostic radiology services (e.g., MRI)||$75-150|
|Oral exam||Not covered|
|Fluoride treatment||Not covered|
|Dental x-ray(s)||Not covered|
|Non-routine services||Not covered|
|Diagnostic services||Not covered|
|Restorative services||Not covered|
|Prosthodontics, other oral/maxillofacial surgery, other services||Not covered|
|Routine eye exam||$40|
|Contact lenses||Not covered|
|Eyeglasses (frames and lenses)||Not covered|
|Eyeglass frames||Not covered|
|Eyeglass lenses||Not covered|
Mental health services
|Inpatient hospital - psychiatric||$500 per stay|
|Outpatient group therapy visit with a psychiatrist||$40|
|Outpatient individual therapy visit with a psychiatrist||$40|
|Outpatient group therapy visit||$40|
|Outpatient individual therapy visit||$40|
Skilled Nursing Facility
|$0 per day for days 1 through 20
$172 per day for days 21 through 100
|Occupational therapy visit||$15|
|Physical therapy and speech and language therapy visit||$15|
Other health plan deductibles?
Foot care (podiatry services)
|Foot exams and treatment||$40|
|Routine foot care||Not covered|
|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)
Medicare Part B drugs
|Other Part B drugs||Not Applicable|
Maximum out-of-pocket enrollee responsibility (does not include prescription drugs)
Optional supplemental benefits
Additional benefits and/or reduced cost-sharing for enrollees with certain health conditions?
Inpatient hospital coverage
|$500 per stay|
Outpatient hospital coverage
|$300 per visit|
|Primary||$15 per visit|
|Specialist||$40 per visit|
Coverage Area for Rocky Mountain Plus Plan (Cost)
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Data as of September 4, 2019.
Star Rating as of October 10, 2019.
Plan Services are 2019 information as reference. 2020 information will be added when released.
Notes: Data are subject to change as contracts are finalized. For 2020, 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 2020 approved contracts. Employer sponsored 800 series and plans under sanction are excluded.