2023 Medicare Blue Choice Select (HMO)

Medicare Blue Choice Select (HMO) H3351-016 is a 2023 Medicare Advantage Plan or Part-C by Excellus Health Plan, Inc available to residents in New York. This plan includes additional prescription drug (Part-D) coverage. Excellus Health Plan, Inc Medicare Blue Choice Select (HMO) has a monthly premium of $0 and has an in-network maximum out-of-pocket limit of $7,900 (MOOP). This means that if you get sick or need a high-cost procedure the co-pays are capped once you pay $7,900 out-of-pocket. This can be an extremely nice safety net.

Excellus Health Plan, Inc works with Medicare to provide significant coverage beyond Part A and Part B benefits. If you decide to sign up for Medicare Blue Choice Select (HMO) you still retain Original Medicare. But you will get additional Part A (Hospital Insurance) and Part B (Medical Insurance) coverage from Excellus Health Plan, Inc and not Original Medicare. With 2023 Medicare Advantage Plan you are always covered for urgently needed and emergency care. Plus, you receive all the benefits of Original Medicare from Excellus Health Plan, Inc except hospice care. Original Medicare still provides you with hospice care if you sign up for Medicare Advantage in New York.




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2023 Excellus Health Plan, Inc Medicare Advantage Plan Overview

Name:Medicare Blue Choice Select (HMO)
Plan ID:H3351 016 0
Provider:Excellus Health Plan, Inc
Year:2023
Type:Local HMO
Combined Premium (C+D):$0/mo
Part C Premium:$0/mo
MOOP:$7,900/yr
Part D (Drug) Premium:$0/mo
Part D Supplemental Premium$0/mo
Total Part D Premium:$0/mo
Drug Deductible:$380.00/yr
Tiers with No Deductible:1
Gap Coverage:No
Benchmark:Not below the regional benchmark
Type of Medicare Health:Enhanced Alternative
Drug Benefit Type:Enhanced
Similar Plan: H3351-017




What type of plan is Medicare Blue Choice Select (HMO)

Medicare Blue Choice Select (HMO) 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 primary care physician 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 primary care physician approval, called a referral. Services received from an out-of-network provider are not typically covered.



How much does Medicare Blue Choice Select (HMO) cost?


Monthly Premium

A monthly premium is the fee you pay to the plan in exchange for coverage. Excellus Health Plan, Inc charges a $0 consolidated premium. The Part C premium is $0 this charge 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

An annual deductible is the amount you pay out-of-pocket for your prescription drugs before your plan begins to pay. Medicare Blue Choice Select (HMO) has a monthly drug premium of $0 and a $380.00 drug deductible. This Excellus Health Plan, 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 Excellus Health Plan, 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 supplemental and basic premiums for some plans this amount can be lowered due to negative basic or supplemental premiums.


Excellus Health Plan, Inc Gap Coverage

In 2023 once you and your plan provider have spent $4660 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 Excellus Health Plan, Inc plan does not offer additional coverage through the gap.


MOOP

The maximum out-of-pocket (MOOP) is a yearly limit on your out-of-pocket costs. Medicare Blue Choice Select (HMO) by Excellus Health Plan, Inc MOOP is $7,900. Once you spend $7,900 you will pay nothing for Part A or Part B covered services. Copayments and coinsurance for Medicare approved services apply toward your out-of-pocket limit. Remember Original Medicare (Parts A and B) doesn’t have a MOOP.



Formulary and Drug Coverage

Medicare Blue Choice Select (HMO) 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 $0 $5
Tier 2 $15 $20
Tier 3 $42 $47
Tier 4 $95 $100
Tier 5 27% 27%

The complete Medicare Blue Choice Select (HMO) Formulary.
*Initial Coverage Phase and 30 day supply





2023 Summary of Benefits


The benefit information provided is a summary of what Medicare Blue Choice Select (HMO) covers and what you pay (such as copayments and coinsurance amounts) for certain common medical events. The Summary of Benefits from Excellus Health Plan, Inc helps get an idea of how much financial protection the plan is generally expected to provide for common health conditions. This section also contains information on coverage for in-network and out-of-network providers.

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



Contact lenses


Vision$0 copay



Eyeglass frames


VisionNot covered



Eyeglass lenses


VisionNot covered



Eyeglasses (frames and lenses)


Vision$0 copay



Other


VisionNot covered



Routine eye exam


Vision$50 copay



Upgrades


VisionNot covered




TransportationNot covered
Skilled Nursing Facility$0 per day for days 1 through 20
$196 per day for days 21 through 100



Occupational therapy visit


Rehabilitation services$40 copay



Physical therapy and speech and language therapy visit


Rehabilitation services$40 copay



Cleaning


Preventive dental$0 copay



Dental x-ray(s)


Preventive dental$0 copay



Fluoride treatment


Preventive dentalNot covered



Oral exam


Preventive dental$0 copay




Preventive care$0 copay
Outpatient hospital coverage$390 copay per visit
In-Network Other health plan deductibles?No
Optional supplemental benefitsNo



Inpatient hospital - psychiatric


Mental health services$315 per day for days 1 through 5
$0 per day for days 6 through 90



Outpatient group therapy visit


Mental health services20% coinsurance



Outpatient group therapy visit with a psychiatrist


Mental health services20% coinsurance



Outpatient individual therapy visit


Mental health services20% coinsurance



Outpatient individual therapy visit with a psychiatrist


Mental health services20% coinsurance



Chemotherapy


Medicare Part B drugs20% coinsurance



Other Part B drugs


Medicare Part B drugs20% coinsurance



Diabetes supplies


Medical equipment/supplies$5 copay per item



Durable medical equipment (e.g., wheelchairs, oxygen)


Medical equipment/supplies20% coinsurance per item



Prosthetics (e.g., braces, artificial limbs)


Medical equipment/supplies20% coinsurance per item




Maximum out-of-pocket enrollee responsibility (does not include prescription drugs)$7,900 In-network
Inpatient hospital coverage$395 per day for days 1 through 5
$0 per day for days 6 through 90



Fitting/evaluation


Hearing$0 copay



Hearing aids


Hearing$499-799 copay



Hearing exam


Hearing$45 copay




Health plan deductible$0
Ground ambulance$250 copay



Foot exams and treatment


Foot care (podiatry services)$45 copay



Routine foot care


Foot care (podiatry services)Not covered



Emergency


Emergency care/Urgent care$95 copay per visit (always covered)



Urgent care


Emergency care/Urgent care$45 copay per visit (always covered)



Primary


Doctor visits$10 copay per visit



Specialist


Doctor visits$45 copay per visit



Diagnostic radiology services (e.g., MRI)


Diagnostic procedures/lab services/imaging$275 copay



Diagnostic tests and procedures


Diagnostic procedures/lab services/imaging$3 copay



Lab services


Diagnostic procedures/lab services/imaging$3 copay



Outpatient x-rays


Diagnostic procedures/lab services/imaging$55 copay



Diagnostic services


Comprehensive dentalNot covered



Endodontics


Comprehensive dental$0 copay



Extractions


Comprehensive dental$0 copay



Non-routine services


Comprehensive dentalNot covered



Periodontics


Comprehensive dental$0 copay



Prosthodontics, other oral/maxillofacial surgery, other services


Comprehensive dental$0 copay



Restorative services


Comprehensive dental$0 copay




In-Network Additional benefits and/or reduced cost-sharing for enrollees with certain health conditions?No




Medicare Blue Choice Select (HMO) Reviews


Is Medicare Blue Choice Select (HMO) a good plan? Medicare Blue Choice Select (HMO) received a 5 overall star rating from the CMS. The CMS uses a Star Rating System to measure how well Medicare Advantage and Part D plans perform. Plans are rated on a one-to-five scale, with one star representing poor performance and five stars representing excellent performance. Medicare Advantage with prescription drug (Part D) coverage (MA-PD) contracts are rated on up to 38 unique quality and performance measures. You can use the CMS star rating to compare Medicare Blue Choice Select Reviews among several different plans.

2022 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
Pain Assessment
Osteoporosis Management
Diabetes Care - Eye Exam
Diabetes Care - Kidney Disease
Diabetes Care - Blood Sugar
Controlling Blood Pressure
Reducing Risk of Falling
Improving Bladder Control
Medication Reconciliation
Statin Therapy


Member Experience with H3351-016 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 Plans Performance

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


Health Plan Customer Service Rating for Excellus Health Plan, Inc

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


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



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Coverage Area

(Click county or state to compare all available Advantage plans)

The availability of Medicare Advantage Plans will vary according to your region. This is why the Coverage Area matters in terms of Medicare eligibility. You will always be eligible for Original Medicare, but eligibility for Medicare Blue Choice Select (HMO) requires you to live in that plan’s service area. The service area is listed below:



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How much does Medicare Blue Choice Select (HMO) cost?

Excellus Health Plan, Inc charges a $0 consolidated monthly premium. A monthly premium is the fee you pay to the plan in exchange for coverage of Medicare medical, hospital benefits and supplemental benefits if offered. You generally are also responsible for paying the Part B premium.

How much is Medicare Blue Choice Select (HMO) MOOP?

The maximum out-of-pocket (MOOP) is a yearly limit on your out-of-pocket costs. Medicare Blue Choice Select (HMO) by Excellus Health Plan, Inc MOOP is $7,900. Once you spend $7,900 you will pay nothing for Part A or Part B covered services.

What type of plan is Medicare Blue Choice Select (HMO)?

Medicare Blue Choice Select (HMO) is a Local HMO. With a health maintenance organization you will be required to receive most of your health care from an in-network provider. HMOs require that you select a primary care physician (PCP).

Is Medicare Blue Choice Select (HMO) a good plan?

Medicare Blue Choice Select (HMO) received a 5 overall star rating from the CMS. The CMS uses a Star Rating System to measure how well plans perform. Plans are rated on a one-to-five scale, with one star representing poor performance and five stars representing excellent performance.



Source:CMS. Data as of Oct 1, 2022.

Last updated on

Notes: Data are subject to change as contracts are finalized. For 2023, 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 2023 approved contracts. Employer sponsored 800 series and plans under sanction are excluded.

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*Licensed Agent Disclaimer: We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE (TTY users should call 1-877-486-2048) 24 hours a day/7 days a week to get information on all of your options.

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