2023 Trinity Health Plan Of New England Cash Back (HMO)

Trinity Health Plan Of New England Cash Back (HMO) H6408-003 is a 2023 Medicare Advantage Plan or Part-C by Trinity Health Plan Of New England available to residents in Connecticut. This plan does not provide extra prescription drug (Part-D) coverage. Trinity Health Plan Of New England Trinity Health Plan Of New England Cash Back (HMO) has a monthly premium of $0 and has an in-network maximum out-of-pocket limit of $6,000 (MOOP). This means that if you get sick or need a high-cost procedure the co-pays are capped once you pay $6,000 out-of-pocket. This can be an extremely nice safety net.

Trinity Health Plan Of New England works with Medicare to provide significant coverage beyond Part A and Part B benefits. If you decide to sign up for Trinity Health Plan Of New England Cash Back (HMO) you still retain Original Medicare. But you will get extra Part A (Hospital Insurance) and Part B (Medical Insurance) coverage from Trinity Health Plan Of New England 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 Trinity Health Plan Of New England except hospice care. Original Medicare still provides you with hospice care if you sign up for Medicare Advantage in Connecticut.



2023 Trinity Health Plan Of New England Medicare Advantage Plan Overview

Name:Trinity Health Plan Of New England Cash Back (HMO)
Plan ID:H6408 003 0
Provider:Trinity Health Plan Of New England
Year:2023
Type:Local HMO *
Combined Premium (C+D):$0/mo
MOOP:$6,000/yr
Similar Plan: H6408-001




What type of plan is Trinity Health Plan Of New England Cash Back (HMO)

Trinity Health Plan Of New England Cash Back (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 Trinity Health Plan Of New England Cash Back (HMO) cost?


Part-C Premium

A monthly premium is the fee you pay to the plan in exchange for coverage. Trinity Health Plan Of New England charges a $0 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.


MOOP

The maximum out-of-pocket (MOOP) is a yearly limit on your out-of-pocket costs. Trinity Health Plan Of New England Cash Back (HMO) by Trinity Health Plan Of New England MOOP is $6,000. Once you spend $6,000 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.





2023 Summary of Benefits


The benefit information provided is a summary of what Trinity Health Plan Of New England Cash Back (HMO) covers and what you pay (such as copayments and coinsurance amounts) for certain common medical events. The Summary of Benefits from Trinity Health Plan Of New England 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


Vision$0 copay



Eyeglass lenses


Vision$0 copay



Eyeglasses (frames and lenses)


Vision$0 copay



Other


VisionNot covered



Routine eye exam


Vision$0 copay



Upgrades


VisionNot covered




TransportationNot covered
Skilled Nursing Facility$0 per day for days 1 through 20
$196 per day for days 21 through 58
$0 per day for days 59 through 100



Occupational therapy visit


Rehabilitation services$30 copay



Physical therapy and speech and language therapy visit


Rehabilitation services$30 copay



Cleaning


Preventive dental$0 copay



Dental x-ray(s)


Preventive dental$0 copay



Fluoride treatment


Preventive dental$0 copay



Oral exam


Preventive dental$0 copay




Preventive care$0 copay
Outpatient hospital coverage$0-250 copay per visit
In-Network Other health plan deductibles?No
Optional supplemental benefitsYes



Inpatient hospital - psychiatric


Mental health services$375 per day for days 1 through 4
$0 per day for days 5 through 90



Outpatient group therapy visit


Mental health services$25 copay



Outpatient group therapy visit with a psychiatrist


Mental health services$25 copay



Outpatient individual therapy visit


Mental health services$25 copay



Outpatient individual therapy visit with a psychiatrist


Mental health services$25 copay



Chemotherapy


Medicare Part B drugs20% coinsurance



Other Part B drugs


Medicare Part B drugs20% coinsurance



Diabetes supplies


Medical equipment/supplies$0 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)$6,000 In-network
Inpatient hospital coverage$375 per day for days 1 through 4
$0 per day for days 5 through 90



Fitting/evaluation


Hearing$0 copay



Hearing aids


Hearing$599-899 copay



Hearing exam


Hearing$35 copay




Health plan deductible$0
Ground ambulance$250 copay



Foot exams and treatment


Foot care (podiatry services)$35 copay



Routine foot care


Foot care (podiatry services)Not covered



Emergency


Emergency care/Urgent care$90 copay per visit (always covered)



Urgent care


Emergency care/Urgent care$35 copay per visit (always covered)



Primary


Doctor visits$0 copay



Specialist


Doctor visits$35 copay per visit



Diagnostic radiology services (e.g., MRI)


Diagnostic procedures/lab services/imaging$175 copay



Diagnostic tests and procedures


Diagnostic procedures/lab services/imaging$0-30 copay



Lab services


Diagnostic procedures/lab services/imaging$0 copay



Outpatient x-rays


Diagnostic procedures/lab services/imaging$15 copay



Diagnostic services


Comprehensive dental$0 copay



Endodontics


Comprehensive dental70% coinsurance



Extractions


Comprehensive dental50% coinsurance



Non-routine services


Comprehensive dentalNot covered



Periodontics


Comprehensive dental70% coinsurance



Prosthodontics, other oral/maxillofacial surgery, other services


Comprehensive dentalNot covered



Restorative services


Comprehensive dental50% coinsurance




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




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 Trinity Health Plan Of New England Cash Back (HMO) requires you to live in that plan’s service area. The service area is listed below:



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How much does Trinity Health Plan Of New England Cash Back (HMO) cost?

Trinity Health Plan Of New England charges a $0 monthly premium. A monthly premium is the fee you pay to the plan in exchange for coverage. The premium covers Medicare medical, hospital benefits and supplemental benefits if offered. You generally are also responsible for paying the Part B premium.

How much is Trinity Health Plan Of New England Cash Back (HMO) MOOP?

The maximum out-of-pocket (MOOP) is a yearly limit on your out-of-pocket costs. Trinity Health Plan Of New England Cash Back (HMO) by Trinity Health Plan Of New England MOOP is $6,000. Once you spend $6,000 you will pay nothing for Part A or Part B covered services.

What type of plan is Trinity Health Plan Of New England Cash Back (HMO)?

Trinity Health Plan Of New England Cash Back (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).



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 extra 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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