Blue Medicare HMO Enhanced (HMO) By Blue Cross and Blue Shield of North Carolinaa
Blue Medicare HMO Enhanced (HMO) is a 2014 Medicare Advantage ("Part C" or "MA Plan") plan by Blue Cross and Blue Shield of North Carolinaa. This plan from Blue Cross and Blue Shield of North Carolinaa works with Medicare to give you significant coverage beyond Part A and Part B benefits. If you decide to sign up for Blue Medicare HMO Enhanced (HMO) you still retain Original Medicare. But you will get additional Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance) coverage from Blue Cross and Blue Shield of North Carolinaa 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: | Blue Medicare HMO Enhanced (HMO) |
|---|---|
| Plan ID: | H3449-005 |
| Provider: | Blue Cross and Blue Shield of North Carolinaa |
| Plan Year: | 2014 |
| Plan Type: | Local HMO |
| Monthly Premium C+D: | $18.90 |
| MOOP: | $3,400 |
Coverage Area for Blue Medicare HMO Enhanced (HMO)
(Click county to compare all available plans)
The Blue Medicare HMO Enhanced (HMO) H3449-005 is available to residents in North Carolina, 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 Blue Medicare HMO Enhanced (HMO) 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.
Blue Medicare HMO Enhanced (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 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 Blue Medicare HMO Enhanced (HMO) H3449
| 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 Blue Medicare HMO Enhanced (HMO)
| 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 Blue Medicare HMO Enhanced (HMO)
| 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
Blue Cross and Blue Shield of North Carolinaa plan charges a $1.00 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 Blue Medicare HMO Enhanced (HMO) plan has a monthly drug premium of $17.90 and a $0.00 drug deductible. This Blue Cross and Blue Shield of North Carolinaa plan offers a $17.90 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 Blue Cross and Blue Shield of North Carolinaa 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 $17.90. 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 Blue Medicare HMO Enhanced (HMO) medicare insurance plan offers a $0.00 premium obligation if you receive a full low-income subsidy (LIS) assistance. And the payment is $4.50 for 75% low income subsidy $8.90 for 50% and $13.40 for 25%.
| Part C Premium: | $1.00 |
|---|---|
| Part D (Drug) Premium: | $17.90 |
| Part D Supplemental Premium | $0.00 |
| Total Part D Premium: | $17.90 |
| 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: | $0.00 |
| 75% LIS Premium: | $4.50 |
| 50% LIS Premium: | $8.90 |
| 25% LIS Premium: | $13.40 |
| Inital Coverage Limit: | $2850 |
| Gap Coverage: | Some 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 Blue Cross and Blue Shield of North Carolinaa plan offers Some Generics through the gap. Some means 10% to 65% of the formulary drugs are covered if you are in 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.
