EON GOLD (PPO C-SNP) By Clear Spring Health
EON GOLD (PPO C-SNP) is a 2020 Medicare Advantage Special Needs Plan plan by Clear Spring Health. This plan from Clear Spring Health 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 Clear Spring Health and not Original Medicare. All Medicare SNPs also provide Medicare additional Part-D drug coverage. EON GOLD (PPO C-SNP) EA-H9589 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.
2020 Medicare Special Needs Plan Details
EON GOLD (PPO C-SNP)
|Special Needs Type:||Chronic or Disabling Condition|
|Provider:||Clear Spring Health|
|Plan Type:||Local PPO|
|Monthly Premium C+D:||$15.00|
The EON GOLD (PPO C-SNP) EA-H9589 is available to residents in Georgia, and all Medicare SNPs must provide Medicare additional prescription drug (Part-D) coverage. EON GOLD (PPO C-SNP) is a Local PPO. A preferred provider organization (PPO) is a medicare plan that has created contracts with a network of "preferred" providers for you to choose from at reduced rates. You do not need to select a primary care physician and you do not need referrals to see other providers in the network. Offering you a little more flexibility overall. You can get medical attention from a provider outside of the network but you will have to pay the difference between the out-of-network bill and the PPOs discounted rate.
Clear Spring Health 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 EON GOLD (PPO C-SNP) plan has a monthly drug premium of $15.00 and a $250.00 drug deductible. This Clear Spring Health plan offers a $15.00 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 Clear Spring Health 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 $15.00. 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.
Depending on your income level you may be eligible for full 75%, 50%, 25% premium assistance. The EON GOLD (PPO C-SNP) medicare insurance plan offers a $0.00 premium obligation if you receive a full low-income subsidy (LIS) assistance. And the payment is $3.70 for 75% low income subsidy $7.50 for 50% and $11.20 for 25%.
|Part C Premium:||$0.00|
|Part D (Drug) Premium:||$15.00|
|Part D Supplemental Premium||$0.00|
|Total Part D Premium:||$15.00|
|Tiers with No Deductible:||1|
|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:||$3.70|
|50% LIS Premium:||$7.50|
|25% LIS Premium:||$11.20|
In 2020 once you and your plan provider have spent $4020 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 25% on generic drugs unless your plan offers additional coverage. This Clear Spring Health plan does not offer additional coverage through the gap.
Clear Spring Health Drug Coverage and Formulary
A formulary is divided into tiers or levels of coverage based on the type or usage of your medication or benefit categories, according to drug costs. Each tier will have a defined out-of-pocket cost that you must pay before receiving the drug. You can see complete 2020 EON GOLD (PPO C-SNP) H9589-001 Formulary here.
Health plan deductible
|$500 annual deductible|
Emergency care/Urgent care
|Emergency||$80 per visit (always covered)|
|Urgent care||$50 per visit (always covered)|
Diagnostic procedures/lab services/imaging
|Diagnostic tests and procedures||Out-of-Network||40%|
|Diagnostic tests and procedures||In-Network||20%|
|Diagnostic radiology services (e.g., MRI)||Out-of-Network||40%|
|Diagnostic radiology services (e.g., MRI)||In-Network||20%|
|Hearing aids||In-Network||$0 copay|
|Oral exam||In-Network||$0 copay|
|Fluoride treatment||Not covered|
|Dental x-ray(s)||In-Network||$0 copay|
|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||Out-of-Network||50%|
|Routine eye exam||In-Network||$0 copay|
|Contact lenses||In-Network||$0 copay|
|Eyeglasses (frames and lenses)||Out-of-Network||50%|
|Eyeglasses (frames and lenses)||In-Network||$0 copay|
|Eyeglass frames||Not covered|
|Eyeglass lenses||Not covered|
Mental health services
|Inpatient hospital - psychiatric||Out-of-Network||40% per stay|
|Inpatient hospital - psychiatric||In-Network||$300 per day for days 1 through 5
$0 per day for days 6 through 90
|Outpatient group therapy visit with a psychiatrist||Out-of-Network||40%|
|Outpatient group therapy visit with a psychiatrist||In-Network||$40|
|Outpatient individual therapy visit with a psychiatrist||Out-of-Network||40%|
|Outpatient individual therapy visit with a psychiatrist||In-Network||$40|
|Outpatient group therapy visit||Out-of-Network||40%|
|Outpatient group therapy visit||In-Network||$40|
|Outpatient individual therapy visit||Out-of-Network||40%|
|Outpatient individual therapy visit||In-Network||$40|
Skilled Nursing Facility
|Out-of-Network||40% per stay|
|In-Network||$0 per day for days 1 through 20
$167 per day for days 21 through 100
|Occupational therapy visit||Out-of-Network||40%|
|Occupational therapy visit||In-Network||$40|
|Physical therapy and speech and language therapy visit||Out-of-Network||40%|
|Physical therapy and speech and language therapy visit||In-Network||$40|
Other health plan deductibles?
Foot care (podiatry services)
|Foot exams and treatment||Out-of-Network||40%|
|Foot exams and treatment||In-Network||$0 copay|
|Routine foot care||Out-of-Network||40%|
|Routine foot care||In-Network||$0 copay|
|Durable medical equipment (e.g., wheelchairs, oxygen)||Out-of-Network||40% per item|
|Durable medical equipment (e.g., wheelchairs, oxygen)||In-Network||20% per item|
|Prosthetics (e.g., braces, artificial limbs)||Out-of-Network||40% per item|
|Prosthetics (e.g., braces, artificial limbs)||In-Network||20% per item|
|Diabetes supplies||Out-of-Network||40% per item|
|Diabetes supplies||In-Network||$0 copay|
Wellness programs (e.g., fitness, nursing hotline)
Medicare Part B drugs
|Other Part B drugs||Out-of-Network||40%|
|Other Part B drugs||In-Network||20%|
Maximum out-of-pocket enrollee responsibility (does not include prescription drugs)
|$10,000 In and Out-of-network
Optional supplemental benefits
Additional benefits and/or reduced cost-sharing for enrollees with certain health conditions?
Inpatient hospital coverage
|Out-of-Network||40% per stay|
|In-Network||$300 per day for days 1 through 5
$0 per day for days 6 through 90
Outpatient hospital coverage
|Out-of-Network||40% per visit|
|In-Network||$225 per visit|
|Primary||Out-of-Network||40% per visit|
|Primary||In-Network||$15 per visit|
|Specialist||Out-of-Network||40% per visit|
|Specialist||In-Network||$50 per visit|
Coverage Area for EON GOLD (PPO C-SNP)
Plans as of September 4, 2019.
Star Rating as of October 11, 2019.
Plan Services are 2019 information as reference. 2020 information will be added when released.
Notes: Data are subject to change. All contracts for 2020 have not been finalized. For 2020, 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 2020 approved contracts/plans. Employer sponsored 800 series plans and plans under sanction are excluded.