Dialysis Complete (HMO-POS C-SNP) By Gold Kidney of Arizona
Dialysis Complete (HMO-POS C-SNP) H4869 004 0 is a 2023 Medicare Advantage Special Needs Plan plan by Gold Kidney of Arizona. This plan from Gold Kidney of Arizona 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 Gold Kidney of Arizona and not Original Medicare. All Medicare SNPs also provide Medicare additional Part-D drug coverage.
Dialysis Complete (HMO-POS C-SNP) H4869-004 is a Chronic Condition SNP (C-SNP). A Chronic Condition SNP is for beneficiaries with the
following severe or disabling chronic conditions: Chronic Lung Disorders. 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.
The Dialysis Complete (HMO-POS C-SNP) H4869-004 is available to residents to
Medicare eligible seniors in Arizona.
All Medicare SNPs must provide Medicare additional prescription drug (Part-D) coverage.
Dialysis Complete (HMO-POS 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.
How much does Dialysis Complete (HMO-POS C-SNP) cost?
A monthly premium is the fee you pay to the plan in exchange for coverage. Gold Kidney of Arizona charges a 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
An annual deductible is the amount you pay out-of-pocket for your prescription drugs before your plan begins to pay. Dialysis Complete (HMO-POS C-SNP) has a monthly drug premium of $42.60 and a $505.00 drug deductible. This Gold Kidney of Arizona plan offers a $42.60 Part-D Basic Premium that is 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 Gold Kidney of Arizona 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 $42.60. 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.
Gold Kidney of Arizona 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 Gold Kidney of Arizona plan does not offer additional coverage through the gap.
Extra Help Premium Assistance
The Low Income Subsidy (LIS) Extra Helps people with Medicare pay for prescription drugs and lowers the costs of Medicare prescription drug coverage. Income limits are based on the Federal Poverty Level (FPL), which changes every year in February or March. The 2022 income limit is $1,719 ($2,309 for couples) per month. Depending on your income level you may be eligible for a full 75%, 50%, 25% premium assistance. The Dialysis Complete (HMO-POS C-SNP) medicare insurance offers a $0 premium obligation if you receive a full low-income subsidy (LIS) assistance. And the payment is $10.60 for 75% low-income subsidy $21.30 for 50% and $31.90 for 25%.
Full Assistance Premium:
75% Assistance Premium:
50% Assistance Premium:
25% Assistance Premium:
H4869-004 Formulary and Drug Coverage
Dialysis Complete (HMO-POS 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 Special Needs Plan that covers your medications. Additionally, you can choose a plan that has your drugs listed at a lower price.
The benefit information provided is a summary of what Dialysis Complete (HMO-POS C-SNP) covers and what you pay (such as copayments and coinsurance amounts) for certain common medical events. The Summary of Benefits from Gold Kidney of Arizona 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.
Prosthodontics, other oral/maxillofacial surgery, other services
In-Network Comprehensive dental
In-Network Comprehensive dental
In-Network Additional benefits and/or reduced cost-sharing for enrollees with certain health conditions?
(Click county or state to compare all available Advantage plans)
The availability of Medicare Special Need 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 Dialysis Complete (HMO-POS C-SNP) requires you to live in that plan’s service area. The service area is listed below:
Notes: Data are subject to change. All contracts for 2023 have not been finalized. For 2023, 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 2023 approved contracts/plans. Employer sponsored 800 series plans 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.