Dual Advantage (HMO SNP)

Do You Have Medicare and Medicaid?

 

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. 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 toward 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 and generic drugs

 

2018 Plan Year

2018 MedStar Medicare Choice Dual Advantage (HMO SNP) - Maryland

Benefit

MedStar Medicare Choice Dual Advantage (HMO SNP)

Monthly Plan Premium

$30.70 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 2017, the amounts for each benefit period were $0 or:

$1,316 deductible for each benefit period:

Days 1-60: $0 per day

Days 61-90: $329 per day

60 Lifetime Reserve Days: $658 per day (Lifetime reserve days can only be used once.)

Skilled Nursing Facility (SNF)

In 2017, the amounts for each benefit period were $0 or:

Days 1-20: $0 for each benefit period

Days 21-100: $164.50 per day

100 days for each benefit period

Doctor Office Visits – Primary Care  Physician (PCP) and Specialist

0% or 20% of the total cost for PCP visits

0% or 20% of the total cost for specialist visits

Outpatient Rehabilitation (e.g., occupational, physical, speech and language therapy)

0% or 20% of the total 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 total cost (up to $80 maximum) per visit

Urgent Care

0% or 20% of the total cost (up to $60 maximum) per visit

Durable Medical Equipment

0% or 20% of the total cost per item

Diabetic Supplies

0% or 20% of the total 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 total cost for lab services

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

0% or 20% of the total 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 measuremen

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

Vision services covered only if provided by a network vision provider

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

Dental services covered only if provided by a network vision provider

Transportation

$0 copay for up to 22 one-way trips

Over-the-Counter (OTC) Drugs

$16 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

If you are eligible for Medicare cost-sharing assistance under Medicaid, your cost-sharing varies based on the level of Extra Help you receive.

Please note, not all plan benefits are listed above. You must continue to pay your Part B premium. For complete benefit information, please see the 2018 Summary of Benefits.

2018 Prescription Drug Coverage Focused on Your Health

The following chart shows the prescription drug coverage provided with our 2018 plan.

Make sure your prescription drugs are covered.

​2018 MedStar Medicare Choice Dual Advantage (HMO SNP) - Maryland

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; or

  • $1.25; or

  • $3.35; or

  • 15% coinsurance*

For all other drugs, members will pay either

  • $0; or

  • $3.70; or

  • $8.35; or

  • 15% coinsurance*

* Your cost-sharing varies based on your level of Medicaid eligibility and the level of Extra Help you receive. For example, individuals who qualify for partial low-income subsidy (LIS)/Extra Help pay 15% coinsurance for prescription drugs.

Initial Coverage Limit (ICL) $3,750
Out-of-Pocket Threshold $5,000
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.

 

2017 Plan Year

2017 MedStar Medicare Choice Dual Advantage (HMO SNP) - Maryland

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)

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 tests, pelvic, prostate, colorectal exams, and bone mass measurement

Routine Vision

$0 copay for routine vision exams

$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 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

$16 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.

Please note, not all plan benefits are listed above. You must continue to pay your Part B premium. For complete benefit information, please see the 2017 Summary of Benefits.

2017 Prescription Drug Coverage Focused on Your Health

The following chart shows the prescription drug coverage provided with our 2017 plan.

Make sure your prescription drugs are covered.

​2017 MedStar Medicare Choice Dual Advantage (HMO SNP) - Maryland

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_18_4013 -  Approved

Last Updated Date: 10/4/2017