Dual Advantage (HMO SNP)

Do You Have Medicare and Medicaid?

Our MedStar Medicare Choice Dual Advantage (HMO SNP) plan offers

  • Free transportation to and from doctors' appointments
  • Routine vision care
  • Preventive and comprehensive dental care
  • Monthly allowance towards over-the-counter health products
  • Care Advisory services to coordinate care
  • Nurse advice line available 24 hours a day, seven days a week
  • Prescription drug coverage for brand name and generic drug

VIDEO: What is MedStar Medicare Choice Dual Advantage (HMO SNP)?

2017 MedStar Medicare Choice Dual Advantage (HMO SNP) - District of Columbia

Benefit MedStar Medicare Choice Dual Advantage (HMO SNP)
Monthly Plan Premium $0 in addition to your Medicare Part B premium
Annual Out-of-Pocket Maximum (your total yearly out-of-pocket costs) $6,700 for all Medicare-covered benefits
Inpatient Hospital Care and Inpatient Mental Health Care

In 2016, the amounts for each benefit period were $0 or

Days 1-60: $1,288 deductible

Days 61-90: $322 per day

60 Lifetime Reserve Days: $644 per day (Lifetime reserve days can only be used once.)

Skilled Nursing Facility (SNF)

In 2016, the amounts for each benefit period were $0 or:

Days 1-20: $0 for each benefit period

Days 21-100: $161 per day

100 days for each benefit period
Doctor Office Visits — Primary Care Physician (PCP) and Specialist 0% or 20%  of the cost for PCP visits
0% or 20%  of the cost for specialist visits
Outpatient Rehabilitation (e.g., occupational, physical, speech and language therapy) 0% or 20%  of the cost per therapy visit
Outpatient Surgery Outpatient Hospital Facility – 0% or 20%  of the cost per surgical procedure
Ambulatory Surgical Center (ASC) – 0% or 20%  of the cost per surgical procedure
Emergency Care 0% or 20% of the cost per visit
Urgent Care 0% or 20% of the cost per visit
Durable Medical Equipment 0% or 20% of the cost per item 
Diabetic Supplies 0% or 20% of the cost per item 
Lab Services, X-rays, and Advanced Imaging Radiology Services (e.g., CT scans, MRI, MRA, PET scans, Nuclear Medicine and Stress tests)

0% or 20%  of the cost for lab services

0% or 20%  of the cost for X-rays or ultrasound

0% or 20%  of the cost for each advanced imaging radiology service

Preventive Services

$0 copay for annual wellness exam, routine physical exam, immunizations (e.g., flu and pneumonia) and preventive screenings, including mammograms, Pap, pelvic, prostate, colorectal exams and bone mass measurement

Routine Vision

$0 copay for one routine eye exam per year

$100 allowance toward the cost of one pair of glasses (frames and lenses) or contact lenses  every year

Preventive and Comprehensive Dental

Routine Preventive Dental Services

  • $0 copay for routine oral exam and cleaning every six months
  • $0 copay for one fluoride treatment per year
  • $0 copay for one dental X-ray per year

Comprehensive Dental Services

Benefit coverage amount of $1,000 a year

Includes: non-routine, diagnostic, restorative, endodontics, periodontics, extractions, prosthodontics, and other oral/maxillofacial surgery

Transportation $0 copay for up to 24 one-way trips
Over-the-Counter (OTC) Drugs $23 allowance each month toward the cost of OTC drugs
Nurse Advice Line Free access to healthcare advice and information from registered nurses, 24 hours a day, 7 days a week
Care Advisory Services Free support to coordinate care for complex health conditions

Depending on your level of Medicaid eligibility, you may not have any cost-sharing responsibility for Original Medicare services or you may pay a coinsurance of 20% of the cost for some services. If you lose your full status, you may be subject to a copay.

We have chosen some of the most important plan features to help you view our plan This plan is available to anyone who has both, Medicaid and Medicare. You must continue to pay your Part B premium. For complete benefit information please see the 2017 Summary of Benefits.

Prescription Drug Coverage Focused on Your Health

The following chart shows the prescription drug coverage provided with our plan.

Make sure your prescriptions drug are covered.

2017 MedStar Medicare Choice Dual Advantage (HMO SNP) - District of Columbia

Prescription Drug Benefit The amount a member pays for their prescription drug coverage depends on income and institutional status. Copay and coinsurance amounts are per prescription or refill
Member Cost Share

For generic drugs (including brand drugs treated as generics), members will pay either

  • $0
  • $1.20
  • $3.30

For all other drugs, members will pay either

  • $0
  • $3.70
  • $8.25
Initial Coverage Limit (ICL) $3,700
Out-of-Pocket Threshold $4,950
Low-income Subsidy (LIS) Dual Advantage members already incur the same cost shares as other members who qualify for LIS assistance and cannot receive additional assistance

 

 

Enroll in Plan Now 

H9915_17_3121 -  Pending CMS Approval

Last Updated Date: 11/8/2016