2023 VIVA Medicare Plus (HMO)

VIVA Medicare Plus (HMO) H0154-015 is a 2023 Medicare Advantage Plan or Part-C by VIVA Medicare available to residents in Alabama. This plan includes additional prescription drug (Part-D) coverage. VIVA Medicare VIVA Medicare Plus (HMO) has a monthly premium of $0 and has an in-network maximum out-of-pocket limit of $5,900 (MOOP). This means that if you get sick or need a high-cost procedure the co-pays are capped once you pay $5,900 out-of-pocket. This can be an extremely nice safety net.

VIVA Medicare works with Medicare to provide significant coverage beyond Part A and Part B benefits. If you decide to sign up for VIVA Medicare Plus (HMO) you still retain Original Medicare. But you will get additional Part A (Hospital Insurance) and Part B (Medical Insurance) coverage from VIVA Medicare 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 VIVA Medicare except hospice care. Original Medicare still provides you with hospice care if you sign up for Medicare Advantage in Alabama.




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2023 VIVA Medicare Medicare Advantage Plan Overview

Name:VIVA Medicare Plus (HMO)
Plan ID:H0154 015 1
Provider:VIVA Medicare
Year:2023
Type:Local HMO
Combined Premium (C+D):$0/mo
Part C Premium:$0/mo
MOOP:$5,900/yr
Part D (Drug) Premium:$0/mo
Part D Supplemental Premium$0/mo
Total Part D Premium:$0/mo
Drug Deductible:$0/yr
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: H0154-016




What type of plan is VIVA Medicare Plus (HMO)

VIVA Medicare Plus (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 VIVA Medicare Plus (HMO) cost?


Monthly Premium

A monthly premium is the fee you pay to the plan in exchange for coverage. VIVA Medicare 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. VIVA Medicare Plus (HMO) has a monthly drug premium of $0 and a $0 drug deductible. This VIVA Medicare 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 VIVA Medicare 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.


VIVA Medicare 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 VIVA Medicare 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. VIVA Medicare Plus (HMO) by VIVA Medicare MOOP is $5,900. Once you spend $5,900 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

VIVA Medicare Plus (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 $4
Tier 2 $12 $12
Tier 3 $47 $47
Tier 4 $100 $100
Tier 5 33% 33%

The complete VIVA Medicare Plus (HMO) Formulary.
*Initial Coverage Phase and 30 day supply





Summary of Benefits

*2021 data this will be updated with 2023 data when available.

The benefit information provided is a summary of what VIVA Medicare Plus (HMO) covers and what you pay (such as copayments and coinsurance amounts) for certain common medical events. The Summary of Benefits from VIVA Medicare 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.




Additional Benefits


No



Comprehensive Dental


Diagnostic services $0 copay
Endodontics $0 copay
Extractions $0 copay
Non-routine services $0 copay
Periodontics $0 copay
Prosthodontics, other oral/maxillofacial surgery, other services $0 copay
Restorative services $0 copay



Deductible


$0



Diagnostic Tests and Procedures


Diagnostic radiology services (e.g., MRI) $15-100 copay
Diagnostic tests and procedures $0-75 copay
Lab services 0-20% coinsurance
Outpatient x-rays $15 copay



Doctor Visits


Primary $0 copay
Specialist $30 copay per visit



Emergency care/Urgent Care


Emergency $90 copay per visit (always covered)
Urgent care $0-40 copay per visit (always covered)



Foot Care (podiatry services)


Foot exams and treatment $30 copay
Routine foot care Not covered



Ground Ambulance


$325 copay



Hearing


Fitting/evaluation Not covered
Hearing aids - inner ear Not covered
Hearing aids - outer ear Not covered
Hearing aids - over the ear Not covered
Hearing exam $0-30 copay



Inpatient Hospital Coverage


$290 per day for days 1 through 6
$0 per day for days 7 through 90



Medical Equipment/Supplies


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



Medicare Part B Drugs


Chemotherapy 20% coinsurance
Other Part B drugs 20% coinsurance



Mental Health Services


Inpatient hospital - psychiatric $290 per day for days 1 through 6
$0 per day for days 7 through 90
Outpatient group therapy visit $30 copay
Outpatient group therapy visit with a psychiatrist $30 copay
Outpatient individual therapy visit $30 copay
Outpatient individual therapy visit with a psychiatrist $30 copay



MOOP


$6,700 In-network



Option


No



Optional supplemental benefits


No



Outpatient Hospital Coverage


$0-275 copay per visit



Preventive Care


$0 copay



Preventive Dental


Cleaning $0 copay
Dental x-ray(s) $0 copay
Fluoride treatment $0 copay
Oral exam $0 copay



Rehabilitation Services


Occupational therapy visit $30 copay
Physical therapy and speech and language therapy visit $30 copay



Skilled Nursing Facility


$0 per day for days 1 through 20
$172 per day for days 21 through 59
$0 per day for days 60 through 100



Transportation


Not covered



Vision


Contact lenses $0 copay
Eyeglass frames $0 copay
Eyeglass lenses $0 copay
Eyeglasses (frames and lenses) $0 copay
Other Not covered
Routine eye exam $0 copay
Upgrades $0 copay



Wellness Programs (e.g. fitness nursing hotline)


Covered




CMS Star Ratings


Is VIVA Medicare Plus (HMO) a good plan? VIVA Medicare Plus (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 VIVA Medicare Plus (HMO) performance 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 H0154-015 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 VIVA Medicare

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 VIVA Medicare Plus (HMO) requires you to live in that plan’s service area. The service area is listed below:



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How much does VIVA Medicare Plus (HMO) cost?

VIVA Medicare 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 VIVA Medicare Plus (HMO) MOOP?

The maximum out-of-pocket (MOOP) is a yearly limit on your out-of-pocket costs. VIVA Medicare Plus (HMO) by VIVA Medicare MOOP is $5,900. Once you spend $5,900 you will pay nothing for Part A or Part B covered services.

What type of plan is VIVA Medicare Plus (HMO)?

VIVA Medicare Plus (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 VIVA Medicare Plus (HMO) a good plan?

VIVA Medicare Plus (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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