MedStar Medicare Choice (HMO)

Our Medicare Advantage plan offers

  • Comprehensive annual physical exam
  • Routine vision care
  • Routine dental care
  • 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 drugs
  • New this year: Access to low cost adherence drugs, including blood pressure medications, statins for cholesterol, and diabetic drugs

VIDEO: What is MedStar Medicare Choice (HMO)?

2017 MedStar Medicare Choice (HMO) - Maryland

Benefit

MedStar Medicare Choice (HMO) - Maryland

Monthly Plan Premium

$17 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

$350 copay per day (days 1-5)  / Acute

$300 copay per day (days 1-5) / Mental Health

Skilled Nursing Facility (SNF)

$0 copay per day (days 1-20)

$160 copay per day (days 21-100)

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

$5 copay for each PCP visit

$50 copay for each specialist visit

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

$40 copay per therapy visit

Outpatient Surgery

Outpatient Hospital Facility – $350 copay per surgical procedure

Ambulatory Surgical Center (ASC) – $250 copay per surgical procedure

Emergency Care

$75 copay per visit

Urgent Care

$40 copay per visit

Durable Medical Equipment

20% of the cost per item

Diabetic Supplies

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 copay per lab visit

$20 copay for general X-rays

$250 copay for the cost of 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 Dental

$45 copay for routine preventive dental visit

Covered routine preventive dental services include

  • Oral exam and cleaning - one every six months
  • Fluoride treatment - one per year
  • Dental X-ray - one per year

Fitness

$0 copay for fitness benefit when using a Silver&Fit network fitness center or gym

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

We have chosen some of the most important plan features to help you view our plan. Not all benefits are listed in these grids. 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. It includes Part D prescription drug coverage with five levels of drug benefits.

  • Preferred generic drugs
  • Generic drugs
  • Preferred brand-name drugs
  • Non-preferred brand-name drugs
  • Specialty drugs
  • Adherence drugs 

Make sure your prescriptions drug are covered.

2017 MedStar Medicare Choice (HMO) - Maryland

There is a $200 Part D deductible applied to drugs on Tiers 3, 4, or 5 of the formulary

Prescription Drugs

One-Month Supply (30 days)

Three-Month Supply (90 days)

Tier 1: Preferred Generic Drugs

$4 copay

Retail: $12 copay

Mail-order: $10 copay

Tier 2: Generic Drugs

$15 copay

Retail: $45 copay

Mail-order: $37.50 copay

Tier 3: Preferred Brand-Name Drugs

$47 copay

Retail: $141 copay

Mail-order: $117.50 copay 

Tier 4: Non-preferred Brand-Name Drugs

$100 copay

Retail: $300 copay

Mail-order: $250 copay 

Tier 5: Specialty Drugs (one-month supply only)

29% of the cost

N/A

Tier 6: Adherence Drugs $3 copay

Retail: $9 copay

Mail-order: $7.50 copay

Coverage Gap

After total yearly drug costs reach $3,700, members will receive a discount on brand-name drugs and generally pay no more than 40% (plus dispensing fee) of the plan’s cost for brand drugs and 51% of the plan’s cost for generic drugs until the yearly out-of-pocket drug costs reach $4,950

Catastrophic Coverage

After the member’s yearly out-of-pocket drug costs reach $4,950

Generic drugs (including brand drugs treated as generic), either

  • $3.30 copay, or
  • 5% coinsurance

For all other drugs, either:

  • $8.25 copay, or
  • 5% coinsurance

 

 

Enroll in Plan Now

H9915_17_3118 -  Pending CMS Approval

Last Updated Date: 11/8/2016