2022 Spirit Rx (HMO-POS)


Spirit Rx (HMO-POS) H5211-004 is a 2022 Medicare Advantage Plan or Part-C by Security Health Plan of Wisconsin, Inc available to residents in Wisconsin. This plan includes additional prescription drug (Part-D) coverage. The Spirit Rx (HMO-POS) has a monthly premium of $229.00 and has an in-network maximum out-of-pocket limit of $1,200 (MOOP). This means that if you get sick or need a high cost procedure the co-pays are capped once you pay $1,200 out-of-pocket. This can be a extremely nice safety net.

Spirit Rx (HMO-POS) 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 require specialized care or a physician specialist, your primary care physician will make the arrangements and inform you where you can go in the network. You will need your PCPs okay, called a referral. Services received from an out-of-network provider are not typically covered.

Security Health Plan of Wisconsin, Inc works with Medicare to provide significant coverage beyond Part A and Part B benefits. If you decide to sign up for Spirit Rx (HMO-POS) you still retain Original Medicare. But you will get additional Part A (Hospital Insurance) and Part B (Medical Insurance) coverage from Security Health Plan of Wisconsin, Inc and not Original Medicare. With Medicare Advantage you are always covered for urgently needed and emergency care. Plus you receive all the benefits of Original Medicare from Security Health Plan of Wisconsin, Inc except hospice care. Original Medicare still provides you with hospice care even if you sign up for Medicare Advantage.




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2022 Security Health Plan of Wisconsin, Inc Medicare Advantage Plan Costs

Name:
Spirit Rx (HMO-POS)
Plan ID:
H5211-004
Provider:Security Health Plan of Wisconsin, Inc
Year:2022
Type: Local HMO
Monthly Premium C+D: $229.00
Part C Premium:$135.60
MOOP: $1,200
Part D (Drug) Premium:$74.90
Part D Supplemental Premium$18.50
Total Part D Premium:$93.40
Drug Deductible:$0.00
Tiers with No Deductible:0
Gap Coverage:No
Benchmark:not below the regional benchmark
Type of Medicare Health:Enhanced Alternative
Drug Benefit Type:Enhanced
Similar Plan: H5211-012
New Plan: 2023 H5211-012




Spirit Rx (HMO-POS) Part-C Premium

Security Health Plan of Wisconsin, Inc charges a $135.60 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.



H5211-004 Part-D Deductible and Premium

Spirit Rx (HMO-POS) has a monthly drug premium of $74.90 and a $0.00 drug deductible. This Security Health Plan of Wisconsin, Inc plan offers a $74.90 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 $18.50 this Premium covers any enhanced plan benefits offered by Security Health Plan of Wisconsin, 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 $93.40 . The Part D Total Premium is the addition of the supplemental and basic premiums for some plans this amount can be lowered due to negative basic or supplemental premiums.



Security Health Plan of Wisconsin, Inc Gap Coverage

In 2022 once you and your plan provider have spent $4430 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 Security Health Plan of Wisconsin, Inc plan does not offer additional coverage through the gap.



Premium Assistance

The Low Income Subsidy (LIS) helps people with Medicare pay for prescription drugs, and lowers the costs of Medicare prescription drug coverage. Depending on your income level you may be eligible for full 75%, 50%, 25% premium assistance. The Spirit Rx (HMO-POS) medicare insurance offers a $51.10 premium obligation if you receive a full low-income subsidy (LIS) assistance. And the payment is $61.70 for 75% low income subsidy $72.30 for 50% and $82.80 for 25%.



Full LIS Premium:$51.10
75% LIS Premium:$61.70
50% LIS Premium:$72.30
25% LIS Premium:$82.80


H5211-004 Formulary or Drug Coverage

Spirit Rx (HMO-POS) 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. You can see complete 2022 Spirit Rx (HMO-POS) H5211-004 Formulary here.

Drug Tier Copay
Preferred
Pharmacy
Copay
Nonpreferred
Pharmacy
Tier 1 NA $9
Tier 2 NA $20
Tier 3 NA $47
Tier 4 NA $100
Tier 5 NA 33%
Tier 6 NA $0
*Initial Coverage Phase and 30 day supply





2021 Spirit Rx (HMO-POS) Summary of Benefits

*This will be updated with 2022 data when available.



Additional Benefits


Yes



Comprehensive Dental


Diagnostic services Not covered
Endodontics Not covered
Extractions Not covered
Non-routine services Not covered
Periodontics Not covered
Prosthodontics, other oral/maxillofacial surgery, other services Not covered
Restorative services Not covered



Deductible


$0



Diagnostic Tests and Procedures


Diagnostic radiology services (e.g., MRI) $150 copay
Diagnostic radiology services (e.g., MRI) $150 copay (Out-of-Network)
Diagnostic tests and procedures $0 copay
Diagnostic tests and procedures $0 copay (Out-of-Network)
Lab services $0 copay
Lab services $0 copay (Out-of-Network)
Outpatient x-rays $0 copay (Out-of-Network)
Outpatient x-rays $0 copay



Doctor Visits


Primary $0 copay
Primary $0 copay (Out-of-Network)
Specialist $25 copay per visit (Out-of-Network)
Specialist $25 copay per visit



Emergency care/Urgent Care


Emergency $120 copay per visit (always covered)
Urgent care $0-25 copay per visit (always covered)



Foot Care (podiatry services)


Foot exams and treatment $25 copay
Foot exams and treatment $25 copay (Out-of-Network)
Routine foot care Not covered



Ground Ambulance


$150 copay



Hearing


Fitting/evaluation $25 copay (Out-of-Network)
Fitting/evaluation $25 copay
Hearing aids $500 copay
Hearing exam $25 copay
Hearing exam $25 copay (Out-of-Network)



Inpatient Hospital Coverage


$250 per stay (Out-of-Network)
$250 per stay



Medical Equipment/Supplies


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



Medicare Part B Drugs


Chemotherapy 20% coinsurance (Out-of-Network)
Chemotherapy 20% coinsurance
Other Part B drugs 20% coinsurance (Out-of-Network)
Other Part B drugs 20% coinsurance



Mental Health Services


Inpatient hospital - psychiatric $250 per stay
Inpatient hospital - psychiatric $250 per stay (Out-of-Network)
Outpatient group therapy visit $25 copay
Outpatient group therapy visit $25 copay (Out-of-Network)
Outpatient group therapy visit with a psychiatrist $25 copay (Out-of-Network)
Outpatient group therapy visit with a psychiatrist $25 copay
Outpatient individual therapy visit $25 copay (Out-of-Network)
Outpatient individual therapy visit $25 copay
Outpatient individual therapy visit with a psychiatrist $25 copay
Outpatient individual therapy visit with a psychiatrist $25 copay (Out-of-Network)



MOOP


$1,200 In and Out-of-network
$1,200 In-network
$1,200 Out-of-network



Option


Yes, contact plan for further details



Optional supplemental benefits


Yes



Outpatient Hospital Coverage


$0-100 copay per visit
$0-100 copay per visit (Out-of-Network)



Package #1


Deductible $100.00
Monthly Premium $34.00



Preventive Care


$0 copay (Out-of-Network)
$0 copay



Preventive Dental


Cleaning $0 copay
Dental x-ray(s) $0 copay
Fluoride treatment Not covered
Oral exam $0 copay



Rehabilitation Services


Occupational therapy visit $20 copay
Occupational therapy visit $20 copay (Out-of-Network)
Physical therapy and speech and language therapy visit $20 copay (Out-of-Network)
Physical therapy and speech and language therapy visit $20 copay



Skilled Nursing Facility


$0 per day for days 1 through 6
$20 per day for days 7 through 20
$0 per day for days 21 through 100 (Out-of-Network)
$0 per day for days 1 through 6
$20 per day for days 7 through 20
$0 per day for days 21 through 100



Transportation


Not covered



Vision


Contact lenses Not covered
Eyeglass frames Not covered
Eyeglass lenses Not covered
Eyeglasses (frames and lenses) $0 copay
Other $0-25 copay (Out-of-Network)
Other $0-25 copay
Routine eye exam $0-25 copay
Routine eye exam $0-25 copay (Out-of-Network)
Upgrades Not covered



Wellness Programs (e.g. fitness nursing hotline)


Covered




CMS Star Ratings for Spirit Rx (HMO-POS) H5211



2021 Overall Rating
Part C Summary Rating
Part-D Summary Rating
Staying Healthy: Screenings, Tests, Vaccines
Managing Chronic (Long Term) Conditions
Member Experience with Health Plan
Complaints and Changes in Plans Performance
Health Plan Customer Service
Drug Plan Customer Service
Complaints and Changes in the Drug Plan
Member Experience with the Drug Plan
Drug Safety and Accuracy of Drug Pricing


Staying Healthy, Screening, Testing, & Vaccines

Total Preventative Rating
Breast Cancer Screening
Colorectal Cancer Screening
Annual Flu Vaccine
Monitoring Physical Activity


Managing Chronic And Long Term Care for Older Adults

Total Rating
SNP Care Management
Medication Review
Functional Status Assessment
Osteoporosis Management
Diabetes Care - Eye Exam
Diabetes Care - Kidney Disease
Diabetes Care - Blood Sugar
Rheumatoid Arthritis
Reducing Risk of Falling
Improving Bladder Control
Medication Reconciliation
Statin Therapy


Member Experience with Health Plan

Total Experience Rating
Getting Needed Care
Getting Appointments
Customer Service
Health Care Quality
Rating of Health Plan
Care Coordination


Member Complaints and Changes in Spirit Rx (HMO-POS) Plans Performance

Total Rating
Complaints about Health Plan
Members Leaving the Plan
Health Plan Quality Improvement


Health Plan Customer Service Rating for Spirit Rx (HMO-POS)

Total Customer Service Rating
Timely Decisions About Appeals
Reviewing Appeals Decisions
Call Center, TTY, Foreign Language


Spirit Rx (HMO-POS) Drug Plan Customer Service Ratings

Total Rating
Call Center, TTY, Foreign Language


Ratings For Member Complaints and Changes in the Drug Plans Performance

Total Rating
Complaints about the Drug Plan
Members Choosing to Leave the Plan
Drug Plan Quality Improvement


Member Experience with the Drug Plan

Total Rating
Rating of Drug Plan
Getting Needed Prescription Drugs


Drug Safety and Accuracy of Drug Pricing

Total Rating
MPF Price Accuracy
Drug Adherence for Diabetes Medications
Drug Adherence for Hypertension (RAS antagonists)
Drug Adherence for Cholesterol (Statins)
MTM Program Completion Rate for CMR
Statin with Diabetes



Ready to Enroll?

Click Here

Or Call
1-855-778-4180
Mon-Fri 8am-8pm EST
Sat 8am-8pm EST




Coverage Area for Spirit Rx (HMO-POS)

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Source: CMS.
Data as of September 1, 2021.
Notes: Data are subject to change as contracts are finalized. For 2022, 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 2022 approved contracts. Employer sponsored 800 series and plans under sanction are excluded.

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