2014 Advocare Essence Rx (HMO-POS) H5211-002 By Security Health Plan of Wisconsin, Inc.

Advocare Essence Rx (HMO-POS) By Security Health Plan of Wisconsin, Inc.

Advocare Essence Rx (HMO-POS) is a 2014 Medicare Advantage ("Part C" or "MA Plan") plan by Security Health Plan of Wisconsin, Inc.. This plan from Security Health Plan of Wisconsin, Inc. works with Medicare to give you significant coverage beyond Part A and Part B benefits. If you decide to sign up for Advocare Essence Rx (HMO-POS) you still retain Original Medicare. But you will get additional Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance) coverage from Security Health Plan of Wisconsin, 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:
Advocare Essence Rx (HMO-POS)
Plan ID:
Provider: Security Health Plan of Wisconsin, Inc.
Plan Year:2014
Plan Type: Local HMO
Monthly Premium C+D: $54.00
MOOP: $3,400

Coverage Area for Advocare Essence Rx (HMO-POS)

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The Advocare Essence Rx (HMO-POS) H5211-002 is available to residents in Wisconsin, and has a in-network Maximum Out-of-Pocket limit of $3,400 MOOP. This means that if you get sick or need a high cost procedure your co-pays are capped. If you enroll in Advocare Essence Rx (HMO-POS) plan you will stop paying co-pays for the rest of the year once you pay out of pocket $3,400 This is a very nice safety net. This plan includes additional Medicare prescription drug (Part-D) coverage.

Advocare Essence Rx (HMO-POS) 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.

Ratings for Advocare Essence Rx (HMO-POS) H5211

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 Advocare Essence Rx (HMO-POS)

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 Advocare Essence Rx (HMO-POS)

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

Part-C Premium

Security Health Plan of Wisconsin, Inc. plan charges a $9.20 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

The Advocare Essence Rx (HMO-POS) plan has a monthly drug premium of $44.80 and a $0.00 drug deductible. This Security Health Plan of Wisconsin, Inc. plan offers a $44.80 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 $0.00 this Premium covers any enhanced plan benefits offered by Security Health Plan of Wisconsin, 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 $44.80. The Part D Total Premium is the addition of the supplemental and basic premiums for some plans this amount can be lower due to negative basic or supplemental premiums.

Premium Assistance

Depending on your income level you may be eligible for full 75%, 50%, 25% premium assistance. The Advocare Essence Rx (HMO-POS) medicare insurance plan offers a $7.80 premium obligation if you receive a full low-income subsidy (LIS) assistance. And the payment is $17.00 for 75% low income subsidy $26.30 for 50% and $35.50 for 25%.

Part C Premium: $9.20
Part D (Drug) Premium: $44.80
Part D Supplemental Premium $0.00
Total Part D Premium: $44.80
Drug Deductible: $0.00
Tiers with No Deductible: 0
Benchmark: not below the regional benchmark
Type of Medicare Health Plan: Enhanced Alternative
Drug Benefit Type: Enhanced
Full LIS Premium: $7.80
75% LIS Premium: $17.00
50% LIS Premium: $26.30
25% LIS Premium: $35.50
Inital Coverage Limit:$2850
Gap Coverage: Few Generics

Gap Coverage

In 2014 once you and your plan provider have spent $2,850 on covered drugs. (combined amount plus your deductible) You will be in the coverage gap. (AKA "donut hole") You will be require to pay 47.5% of the plan's cost for covered brand-name prescription drugs and 72% of the cost for generic drugs unless your plan offers additional coverage. This Security Health Plan of Wisconsin, Inc. plan offers Few Generics through the gap. Few means 0% to 10% of the formulary drugs are covered if your are in the gap and must also be greather then 15 "brand" products covered through the gap.

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.

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