2016 Medicare Advantage Special Needs Plans (SNP) Full Dual Medicare & Medicaid Maricopa County
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- John Sanders
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1 2016 Medicare Advantage Special Needs Plans (SNP) Full Dual Medicare & Medicaid Maricopa County Special Needs Plans for Dual Eligible beneficiaries are an HMO plan that limits their membership to people who are eligible for both Medicare and Medicaid (AHCCCS). The Special Needs Plan must be designed to provide Medicare health care and services to people who can benefit the most from things like special expertise of the plan s providers, and focused care management. In some cases, you may have to choose a primary care doctor or have a care coordinator help you develop personal care plans and coordinate your care. You generally must get your care and services from doctors or hospitals in the plan s network (except emergency or urgent care). Most current revision 10/12/15 BENEFITS ASSISTANCE PROGRAM A State Health Insurance Assistance Program (SHIP) A program of the Area Agency on Aging, Region One 1366 East Thomas, Suite 108, Phoenix, AZ The Benefits Assistance Program, part of the AZ State Health Insurance and Assistance Program (SHIP), does not recommend or endorse any particular company or plan and is not responsible for the service provided by these companies. These comparison sheets are provided as a guide to assist you in making your health care decisions. This publication has been created or produced by the Area Agency on Aging, Region One with financial assistance, in whole or in part, through a grant from the Administration for Community Living
2 Full Dual Special Needs Plans (SNP) Page 1. Bridgeway Health Solutions Advantage (Bridgeway ALTCS) 3 2. Health Choice Generations (Aligned with Health Choice) 5 3. Health Net Amber (Aligned with Health Net) 7 4. Maricopa Care Advantage (Aligned with Maricopa Health Plan) 9 5. Mercy Care Advantage Plan (Aligned with Mercy Care & MMIC) Care1st+ (Aligned with Care 1 st ) Phoenix Advantage Plus (Aligned with Phoenix Health Plan) United Healthcare Dual Complete (Aligned with UHC CP)
3 Bridgeway Health Solutions Advantage SNP (HMO) Plan Number H Bridgeway Health advantage.bridgewayhs.com STAR RATING = 3.5 STARS Must be eligible for Medicare and be enrolled in an ALTCS health plan Premiums, co-pays and coinsurance will be paid by AHCCCS Providers must have contract with Bridgeway ALTCS plan Monthly Premium for this plan $0.00 Inpatient Hospital Deductible day for days 1 90 Skilled Nursing Facility Co-pay per day for days 1 20 (3 day prior hospital stay required) Co-pay per day for days (100 days per benefit period) Outpatient Mental Health Emergency/Urgent Care Co-pay per hospital emergency room visit (waived if admitted) for urgent care Ambulance Services Co-pay per trip Physician Services Co-pay for Primary Care Physician Co-pay for Specialist Physical, Occupational, Speech Therapy Routine Podiatry Service Chiropractic Care Diagnostic Tests, X-Rays, and Lab Services Clinical/diagnostic lab service Outpatient Services Facility co-pay at ambulatory surgical center Facility co-pay per outpatient hospital facility visit Prescription Drugs $1.20 or $3.60 Home Health Care Durable Medical Equipment (DME) Co-pay per item for Diabetic supplies Co-pay per piece of equipment Co-pay per prosthetic device Vision Services Co-pay per Medicare covered eye exam $0.00 Co-pay per annual vision exam $0.00 Frames/lenses $ annual limit Contact Lenses $150 annual limit Hearing Services Co-pay for Medicare covered hearing exam $0.00 Co-pay for annual hearing exam $0.00 Hearing aid appliance Transportation Dental Cleaning and Oral Exam every 6 months $0.00
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5 Health Choice Generations SNP (HMO) Plan Number H Health Choice healthchoicegenerations.com STAR RATING = 3 STARS Must be eligible for Medicare and be enrolled in an AHCCCS health plan Premiums, co-pays and coinsurance will be paid by AHCCCS Providers must have contract with Health Choice AHCCCS plan Monthly Premium for this plan $0.00 Inpatient Hospital Co-pay per day for days 1 90 Skilled Nursing Facility Co-pay per day for days 1 20 (no prior hospital stay required) Co-pay per day for days (100 days per benefit period) Outpatient Mental Health Emergency/Urgent Care Co-pay per hospital emergency room visit (waived if admitted) for urgent care Ambulance Services Co-pay per trip Physician Services Co-pay for Primary Care Physician Co-pay for Specialist Physical, Occupational, Speech Therapy Routine Podiatry Service Chiropractic Care Diagnostic Tests, X-Rays, and Lab Services Clinical/diagnostic lab service Outpatient Services Facility co-pay at ambulatory surgical center Facility co-pay per outpatient hospital facility visit Prescription Drugs $1.20 or $3.60 Home Health Care Durable Medical Equipment (DME) Co-pay per item for Diabetic supplies Co-pay per piece of equipment Co-pay per prosthetic device Vision Services Co-pay per Medicare covered eye exam $0.00 Co-pay per annual vision exam $0.00 Frames/lenses/contacts benefit $175 annual limit Hearing Services Co-pay for Medicare covered hearing exam $0.00 Co-pay for annual hearing exam $0.00 Hearing aid appliance (annual benefit) $ Transportation Dental Cleaning and oral exam every year $
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7 Health Net Amber SNP (HMO) Plan Number H Health Net of Arizona healthnet.com/medicare STAR RATING = 3.5 STARS Must be eligible for Medicare and be enrolled in an AHCCCS health plan Premiums, co-pays and coinsurance will be paid by AHCCCS Providers must have contract with Health Net AHCCCS plan Monthly Premium for this plan $0.00 Inpatient Hospital Abrazo, Dignity, and St. Lukes Hospital Networks Only Deductible day for days 1 90 Skilled Nursing Facility Co-pay per day for days 1 20 (3 day prior hospital stay required) Co-pay per day for days (100 days per benefit period) Outpatient Mental Health Emergency/Urgent Care Co-pay per hospital emergency room visit (waived if admitted) for urgent care Ambulance Services Co-pay per trip Physician Services Co-pay for Primary Care Physician Co-pay for Specialist Physical, Occupational, Speech Therapy Routine Podiatry Service Chiropractic Care Diagnostic Tests, X-Rays, and Lab Services Clinical/diagnostic lab service Outpatient Services Facility co-pay at ambulatory surgical center Facility co-pay per outpatient hospital facility visit Prescription Drugs $1.20 or $3.60 Home Health Care Durable Medical Equipment (DME) Co-pay per item for Diabetic supplies Co-pay per piece of equipment Co-pay per prosthetic device Vision Services Co-pay per Medicare covered eye exam $0.00 Co-pay per annual vision exam Frames/lenses/contacts Hearing Services Co-pay for Medicare covered hearing exam $0.00 Co-pay for annual hearing exam $0.00 Hearing aid appliance benefit $1,000 (every 3 years) Transportation Dental Annual Dental Benefit $2,000.00
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9 Maricopa Care Advantage SNP (HMO) Plan Number H University of Arizona universitycareadvantage.com STAR RATING = 3 STARS Must be eligible for Medicare and enrolled in an AHCCCS health plan Premiums, co-pays and coinsurance will be paid by AHCCCS Providers must have contract with Maricopa Health AHCCCS plan Monthly Premium for this plan $0.00 Inpatient Hospital Co-pay per day for days 1 90 Skilled Nursng Facility Co-pay per day for days 1 20 (no prior hospital stay required) Co-pay for days Outpatient Mental Health Emergency/Urgent Care Co-pay per hospital emergency room visit (waived if admitted) for urgent care Ambulance Services Co-pay per trip (waived if admitted) Physician Services Co-pay for Primary Care Physician Co-pay for Specialist Physical Occupational Speech Therapy Routine Podiatry Service Chiropractic Care Diagnostic Tests, X-Rays, and Lab Services Clinical/diagnostic lab service Outpatient Services Facility co-pay at ambulatory surgical center Facility co-pay per outpatient hospital facility visit Prescription Drugs $1.20 or $3.60 Home Health Care Durable Medical Equipment (DME) Co-pay per item for Diabetic supplies Co-pay per piece of equipment Co-pay per prosthetic device Vision Services Co-pay per Medicare covered eye exam $0.00 Co-pay per annual vision exam Frames/lenses/contacts Hearing Services Co-pay for Medicare covered hearing exam $0.00 Co-pay for annual hearing exam Hearing aid appliance Transportation Dental Limited dental benefits $0.00 to 20% - 9 -
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11 Mercy Care Advantage SNP (HMO) Plan Number H Mercy Care Advantage mercycareadvantage.com STAR RATING = 3 STARS Must be eligible for Medicare and be enrolled in an AHCCCS health plan Premiums, co-pays and coinsurance will be paid by AHCCCS Providers must have contract with Mercy Care AHCCCS plan Monthly Premium for this plan $0.00 Inpatient Hospital Co-pay per day for days 1 60 Skilled Nursing Facility Co-pay per day for days 1 20 (3 day hospital stay required) Co-pay per day for days (100 days per benefit period) Outpatient Mental Health Emergency/Urgent Care Co-pay per hospital emergency room visit (waived if admitted) for urgent care Ambulance Services Co-pay per trip Physician Services Co-pay for Primary Care Physician Co-pay for Specialist Physical, Occupational, Speech Therapy Routine Podiatry Service Chiropractic Care Diagnostic Tests, X-Rays, and Lab Services Clinical/diagnostic lab service Outpatient Services Facility co-pay at ambulatory surgical center Facility co-pay per outpatient hospital facility visit Prescription Drugs $1.20 or $3.60 Home Health Care Durable Medical Equipment (DME) Co-pay per item for Diabetic supplies Co-pay per piece of equipment Co-pay per prosthetic device Vision Services Co-pay per Medicare covered eye exam $0.00 Co-pay per annual vision exam $0.00 Benefit for frames/lenses/contacts $200 (every 2 years) Hearing Services Co-pay for Medicare covered hearing exam $0.00 Co-pay for annual hearing exam $0.00 Hearing aid appliance benefit $1,200 (every 3 years) Transportation Dental Cleaning and oral exam every 6 months $
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13 Care 1 st + SNP (HMO Plan Number H STAR RATING = 3.5 STARS Care 1 st Health Plan of AZ care1st.com/az/medicare Must be eligible for Medicare and AHCCCS health plan Premiums, co-pays and coinsurance will be paid by AHCCCS Providers must have contract with Care 1st AHCCCS plan Monthly Premium for this plan $0.00 Inpatient Hospital Co-pay per day for days 1 60 Co-pay per day for days (90 days per benefit period) Skilled Nursing Facility Co-pay per day for days 1 20 (3 day hospital stay required) Co-pay per day for days (100 days per benefit period) Outpatient Mental Health Emergency/Urgent Care Co-pay per hospital emergency room visit (waived if admitted) for urgent care (waived if admitted) Ambulance Services Co-pay per trip Physician Services Co-pay for Primary Care Physician Co-pay for Specialist Physical, Occupational, Speech Therapy Routine Podiatry Service Chiropractic Care Diagnostic Tests, X-Rays, and Lab Services Clinical/diagnostic lab service Outpatient Services Facility co-pay at ambulatory surgical center Facility co-pay per outpatient hospital facility visit Prescription Drugs $1.20 or $3.60 Home Health Care Durable Medical Equipment (DME) Co-pay per item for Diabetic supplies Co-pay per piece of equipment Co-pay per prosthetic device Vision Services Co-pay per Medicare covered eye exam $0.00 Co-pay per annual vision exam $0.00 Frames/lenses/contacts $350 (every year) Hearing Services Co-pay for Medicare covered hearing exam $0.00 Co-pay for annual hearing exam $0.00 Hearing aid appliance benefit $1,200 (every 3 years) Transportation (check with plan for details) $0.00 Dental Annual benefit for dental services $1,250
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15 Phoenix Advantage Plus SNP (HMO) Plan Number H Phoenix Health Plan phoenixhealthplans.com STAR RATING = 2.5 STARS Must be eligible for Medicare and be enrolled in an AHCCCS health plan Premiums, co-pays and coinsurance will be paid by AHCCCS Providers must have contract with Phoenix Health AHCCCS plan Monthly Premium for this plan $0.00 Inpatient Hospital NOT ACCEPTED AT ANY SCOTTSDALE HEALTHCARE FACILITY Co-pay per day for days 1 60 Plan covers 90 days each benefit period Skilled Nursing Facility Co-pay per day for days 1 20 (3 day prior hospital stay required) Co-pay per day for days (100 days per benefit period) Outpatient Mental Health Emergency/Urgent Care Co-pay per hospital emergency room visit (waived if admitted) for urgent care Ambulance Services Co-pay per trip Physician Services Co-pay for Primary Care Physician Co-pay for Specialist Physical, Occupational, Speech Therapy Routine Podiatry Service Chiropractic Care Diagnostic Tests, X-Rays, and Lab Services Clinical/diagnostic lab service Outpatient Services Facility co-pay at ambulatory surgical center Facility co-pay per outpatient hospital facility visit Prescription Drugs $1.20 or $3.60 Home Health Care Durable Medical Equipment (DME) Co-pay per item for Diabetic supplies Co-pay per piece of equipment Co-pay per prosthetic device Vision Services Co-pay per Medicare covered eye exam $0.00 Co-pay per annual vision exam $0.00 Frames/lenses/contacts benefit $200 (every year) Hearing Services Co-pay for Medicare covered hearing exam $0.00 Co-pay for annual hearing exam $0.00 Hearing aid appliance benefit $1,500 (every 2 years) Transportation Dental Cleaning and oral exam every year $0.00
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17 United Healthcare Dual Complete SNP (HMO) Plan Number H PLAN RATING = 3 STARS UHC Community Plan UHCdualcomplete.com Must be eligible for Medicare and AHCCCS health plan Premiums, co-pays and coinsurance will be paid by AHCCCS Providers must have contract with United Healthcare/APIPA AHCCCS plan Monthly Premium for this plan $0.00 Inpatient Hospital Co-pay per day for days 1-60 Co-pay per day for days Skilled Nursing Facility Co-pay per day for days 1 20 (3 day hospital stay required) Co-pay per day for days (100 days per benefit period) Outpatient Mental Health Emergency/Urgent Care Co-pay per hospital emergency room visit (waived if admitted) for urgent care (waived if admitted) Ambulance Services Co-pay per trip Physician Services Co-pay for Primary Care Physician Co-pay for Specialist Physical, Occupational, Speech Therapy Routine Podiatry Service Chiropractic Care Diagnostic Tests, X-Rays, and Lab Services Clinical/diagnostic lab service Outpatient Services Facility co-pay at ambulatory surgical center Facility co-pay per outpatient hospital facility visit Prescription Drugs $1.20 or $3.60 Home Health Care Durable Medical Equipment (DME) Co-pay per item for Diabetic supplies Co-pay per piece of equipment Co-pay per prosthetic device Vision Services Co-pay per Medicare covered eye exam $0.00 Co-pay per annual vision exam $0.00 Benefit for frames/lenses/contacts $150 (every 2 years) Hearing Services Co-pay for Medicare covered hearing exam $0.00 Co-pay for annual hearing exam $0.00 Hearing aid appliance benefit $1,500 (every 2 years) Transportation (check with plan for details) $0.00 Dental Annual benefit for dental services $1,500
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