2021 Imperial Senior Value (HMO C-SNP) EA-H5496

Imperial Senior Value (HMO C-SNP) By Imperial Health Plan of California, Inc.



Imperial Senior Value (HMO C-SNP) is a 2021 Medicare Advantage Special Needs Plan plan by Imperial Health Plan of California, Inc.. This plan from Imperial Health Plan of California, Inc. 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 Imperial Health Plan of California, Inc. and not Original Medicare. All Medicare SNPs also provide Medicare additional Part-D drug coverage. Imperial Senior Value (HMO C-SNP) EA-H5496 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.



2021 Medicare Special Needs Plan Details

Plan Name:
Imperial Senior Value (HMO C-SNP)
Plan ID:
EA-H5496
Special Needs Type: Chronic or Disabling Condition
Provider: Imperial Health Plan of California, Inc.
Plan Year:2021
Plan Type: Local HMO
Monthly Premium C+D: $0


The Imperial Senior Value (HMO C-SNP) EA-H5496 is available to residents in California, and all Medicare SNPs must provide Medicare additional prescription drug (Part-D) coverage. Imperial Senior Value (HMO C-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

Imperial Health Plan of California, Inc. plan charges a $0 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 Imperial Senior Value (HMO C-SNP) plan has a monthly drug premium of $0 and a $0 drug deductible. This Imperial Health Plan of California, Inc. plan offers a $0 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 this Premium covers any enhanced plan benefits offered by Imperial Health Plan of California, Inc. 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 $0 . 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 Imperial Senior Value (HMO C-SNP) medicare insurance plan offers a $0 premium obligation if you receive a full low-income subsidy (LIS) assistance. And the payment is $0 for 75% low income subsidy $0 for 50% and $0 for 25%.



Part C Premium: $0
Part D (Drug) Premium: $0
Part D Supplemental Premium $0
Total Part D Premium: $0
Drug Deductible: $0
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: $0
75% LIS Premium: $0
50% LIS Premium: $0
25% LIS Premium: $0
Gap Coverage: Yes


Gap Coverage

In 2021 once you and your plan provider have spent $4130 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 Imperial Health Plan of California, Inc. plan does offer additional coverage through the gap.




Imperial Senior Value (HMO C-SNP) Part-C Premium

Imperial Health Plan of California, Inc. plan charges a $0 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.



EA-H5496 Part-D Deductible and Premium

Imperial Senior Value (HMO C-SNP) has a monthly drug premium of $0 and a $0 drug deductible. This Imperial Health Plan of California, Inc. plan offers a $0 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 this Premium covers any enhanced plan benefits offered by Imperial Health Plan of California, Inc. 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 $0 . 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.



Imperial Health Plan of California, Inc. Gap Coverage

In 2021 once you and your plan provider have spent $4130 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 prescription drugs unless your plan offers additional coverage. This Imperial Health Plan of California, Inc. plan does offer additional coverage through the gap.



EA-H5496 Formulary or Drug Coverage

Imperial Senior Value (HMO C-SNP) formulary is divided into tiers or levels of coverage based on usage and according to the medication costs. Each tier will have a defined copay that you must pay to receive the drug. Drugs in lower tiers will usually cost less than those in higher tiers. By reviewing different Medicare Drug formularies, you can pick a Medicare Advantage plan that covers your medications. Additionally, you can choose a plan that has your drugs listed at a lower price.

Drug Tier Copay
Preferred
Pharmacy
Copay
Nonpreferred
Pharmacy
Tier 1 NA $0
Tier 2 NA $5
Tier 3 NA $45
Tier 4 NA $90
Tier 5 NA 33%
Tier 6 NA $3
*Initial Coverage Phase and 30 day supply








Coverage Area for Imperial Senior Value (HMO C-SNP)



Source: CMS.

Plans as of September 9, 2020.

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.

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