ADVANTAGE Preferred (PPO) By ADVANTAGE Health Solutions, Inc.
ADVANTAGE Preferred (PPO) is a 2014 Medicare Advantage ("Part C" or "MA Plan") plan by ADVANTAGE Health Solutions, Inc.. This plan from ADVANTAGE Health Solutions, Inc. works with Medicare to give you significant coverage beyond Part A and Part B benefits. If you decide to sign up for ADVANTAGE Preferred (PPO) you still retain Original Medicare. But you will get additional Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance) coverage from ADVANTAGE Health Solutions, Inc. and not Original Medicare. With Medicare Advantage plans your always covered for urgently needed and emergency care and you receive all of the benefits of Original Medicare from this plan except hospice care. Original Medicare still provides you with hospice care even if you sign up for a Medicare Advantage Plan.
2014 Medicare Advantage Plan Details
| Plan Name: | ADVANTAGE Preferred (PPO) |
|---|---|
| Plan ID: | H5508-002 |
| Provider: | ADVANTAGE Health Solutions, Inc. |
| Plan Year: | 2014 |
| Plan Type: | Local PPO * |
| Monthly Premium C+D: | $- |
| MOOP: | $4,000 |
Coverage Area for ADVANTAGE Preferred (PPO)
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The ADVANTAGE Preferred (PPO) H5508-002 is available to residents in Indiana, and has a in-network Maximum Out-of-Pocket limit of $4,000 MOOP. This means that if you get sick or need a high cost procedure your co-pays are capped. If you enroll in ADVANTAGE Preferred (PPO) plan you will stop paying co-pays for the rest of the year once you pay out of pocket $4,000 This is a very nice safety net. This plan does not provide additional Medicare prescription drug (Part-D) coverage.
ADVANTAGE Preferred (PPO) is a Local PPO *. A preferred provider organization (PPO) is a medicare plan that has created contracts with a network of "preferred" providers for you to choose from at reduced rates. You do not need to select a primary care physician and you do not need referrals to see other providers in the network. Offering you a little more flexibility overall. You can get medical attention from a provider outside of the network but you will have to pay the difference between the out-of-network bill and the PPOs discounted rate.
Ratings for ADVANTAGE Preferred (PPO) H5508
| 2014 Overall Rating | ||
|---|---|---|
| Part C Summary Rating | ||
| Total Experience Rating | ||
| Complaints, Improvements | ||
| Total Customer Service Rating | ||
| Total Preventative Rating | ||
| Chronic And Long Term Care |
Member Experience Rating for ADVANTAGE Preferred (PPO)
| Total Experience Rating | ||
|---|---|---|
| Getting Needed Care | ||
| Timely Care and Appointments | ||
| Customer Service | ||
| Health Care Quality | ||
| Rating of Health Plan | ||
| Care Coordination |
Member Complaints, Problems Getting Service and Improvements in Health Plans
| Total Rating | ||
|---|---|---|
| Members Leaving the Plan | ||
| Complaints about Health Plan | ||
| Access to Service | ||
| Performance Problems | ||
| Health Plan Quality Improvement |
Customer Service Rating for ADVANTAGE Preferred (PPO)
| Total Customer Service Rating | ||
|---|---|---|
| Timely Decisions About Appeals | ||
| Reviewing Appeals Decisions | ||
| Call Center |
Staying Healthy, Screening, Testing, & Vaccines
| Total Preventative Rating | ||
|---|---|---|
| Breast Cancer Screening | ||
| Colorectal Cancel Screening | ||
| Cardiovascular Screening | ||
| Diabetes Care | ||
| Glaucoma Testing | ||
| Annual Flu Vaccine | ||
| Improving Physical | ||
| Improving Mental Health | ||
| Monitoring Physical Activity | ||
| Adult BMI Assessment |
Ratings For Managing Chronic And Long Term Care
| Total Rating | ||
|---|---|---|
| Medication Review | ||
| Functional Status Assessment | ||
| Pain Screening | ||
| Osteoporosis Management | ||
| Diabetes Care - Eye Exam | ||
| Diabetes Care - Kidney Disease | ||
| Diabetes Care - Blood Sugar | ||
| Diabetes Care - Cholesterol | ||
| Controlling Blood Pressure | ||
| Rheumatoid Arthritis | ||
| Improving Bladder Control | ||
| Reducing Risk of Falling | ||
| Plan - Cause Readmissions |
Source: CMS.
Plans as of September 3, 2013.
Star Rating as of September 27, 2013.
For More Information on Ratings Please See the CMS Tech Notes Here.
Plans are subject to change as contracts are finalized.
Includes 2014 approved contracts/plans. Employer sponsored 800 series plans and plans under sanction are excluded.
