Cigna-HealthSpring Advantage Lauderdale County, Alabama 2016 Medicare Advantage Plan H0150-012

HMO Plan
$0.00
5-Star Rating:{plan}, a Medicare Advantage plan available in Lauderdale County, AL, an average Medicare rating of 3.0 out of 5 stars.
Plan ID:H0150-012
Plan Year:2016
Full Premium:$0.00/mo
Annual MOOP:$6,700
Part D Benefit:No
Rx Deductible:$0.00/year
Rx Gap Coverage:
Online Pharmacy:No
Plan Phone #:855-552-0698
Summary of Benefits: Cigna-HealthSpring Advantage Medicare Advantage Plan H0150-012 Summary of Benefits for Lauderdale County, Alabama

Cigna-HealthSpring Advantage Medicare Advantage Plan for Lauderdale County, Alabama seniors on Medicare.Cigna-HealthSpring Advantage is a Health Maintenance Organization (HMO) Medicare Advantage plan, by Cigna-HealthSpring, available in Lauderdale County, Alabama. It offers all of the basic benefits of Original Medicare and may include additional coverage.

With an HMO plan, like this one from Cigna-HealthSpring, your out-of-pocket costs are much lower than Original Medicare. That's the big advantage.

IMPORTANT: You must use providers in the Cigna-HealthSpring network to avoid incurring additional costs. You are responsible for all costs incurred out of network. Referrals are generally required to see specialists.

Monthly Premium

This plan has a zero dollar premium!

The Cigna-HealthSpring Advantage premium is zero dollar, however, it is not free. You continue make your Medicare Part B premium payment and that covers the full cost. If your income is over $85,000 ($170,000 for married couples) a year, or you have a penalty due to late enrollment, you pay the standard Part B premium.

IMPORTANT NOTICE: Double-digit price hikes for Medicare Part B premiums are coming in 2016. The base tier premium is expected to jump from $104.90 to $120.70.

Your monthly premium is independent of the healthcare services you use. When you see your doctor, or if you are admitted into the hospital for treatment, you have copayments. Your prescriptions also have copayments.

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Maximum Out-of-Pocket Limit

All 2016 Medicare Advantage plans have a $6,700 maximum out-of-pocket (MOOP) limit. That said, Medicare allows for a voluntary MOOP as low as $3,400.This plan's MOOP is $6,700. This figure is not inclusive of your monthly premium or the cost of your prescriptions (Medicare Part D Coverage).

This means that you will no longer pay copayment or coinsurance as soon as your copayments and coinsurance for doctor visits and hospital care reaches $6,700. This is your guarantee that an illness or accident will send you into bankruptcy. Consider the MOOP along with the premium and the copay.

If you're comparing this plan with Original Medicare, don't forget that you pay about 20% of all covered expenses, but there's no limit. You have a lot of risk with Original Medicare unless you buy a Medicare Supplement to cover your copayments and coinsurances.

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Coverage, Copayments & Coinsurance

The Cigna-HealthSpring Advantage plan offers the same basic benefits as Original Medicare. The big difference is copayments and coinsurances. Below you will find (where available) what you will pay for common health care services.

Doctor Visits

Most plans have copayments when you see your primary care doctor or a specialist. Here's how this plan works:

  • Acupuncture and Other Alternative Therapies
  • Not covered
  • Ambulance Services
  • $150 co-pay or 20% of the cost depending on the service
  • Chiropractic Care
  • Manipulation of the spine to correct a subluxation (when 1 or more of the bones of your spine move out of position): $20 copay
  • Dental Services
  • Limited dental services (this does not include services in connection with care treatment filling removal or replacement of teeth): $40 copay
  • Preventive dental services:
  • Cleaning (for up to 1 every six months): No cost to you .
  • Dental x-ray(s) (for up to 1 every year): No cost to you .
  • Oral exam (for up to 1 every six months): No cost to you .
  • Diabetes Supplies and Services
  • Diabetes monitoring supplies: 0-20% of the cost depending on the supply
  • Diabetes self-management training: No cost to you
  • Therapeutic shoes or inserts: 20% of the cost
  • Diagnostic Tests, Lab and Radiology Services, and X-Rays
  • Diagnostic radiology services (such as MRIs CT scans): $0-200 co-pay depending on the service
  • Diagnostic tests and procedures: $0-200 co-pay depending on the service
  • Lab services: No cost to you
  • Outpatient x-rays: $30 copay
  • Therapeutic radiology services (such as radiation treatment for cancer): $60 copay
  • Doctor's Office Visits
  • Primary care physician visit: No cost to you
  • Specialist visit: $40 copay
  • Durable Medical Equipment (wheelchairs, oxygen, etc.)
  • 20% of the cost
  • Emergency Care
  • $65 copay
  • If you are admitted to the hospital within 24 hours you do not have to pay your share of the cost for emergency care. See the Inpatient Hospital Care section for other costs.
  • Foot Care (podiatry services)
  • Foot exams and treatment if you have diabetes-related nerve damage and/or meet certain conditions: $40 copay
  • Hearing Services
  • Exam to diagnose and treat hearing and balance issues: $0-40 co-pay depending on the service
  • Home Health Care
  • No cost to you
  • Mental Health Care
  • Inpatient visit:
  • Cigna-HealthSpring Advantage covers up to 190 days in a lifetime for inpatient mental health care in a psychiatric hospital. The inpatient hospital care limit does not apply to inpatient mental services provided in a general hospital.
  • Cigna-HealthSpring Advantage covers 90 days for an inpatient hospital stay.
  • Cigna-HealthSpring Advantage also covers 60 lifetime reserve days. These are extra days Cigna-HealthSpring Advantage covers. If you are an inpatient for more than 90 days you can use these extra days. But once you have used up these extra 60 days your inpatient hospital coverage will be limited to 90 days.
  • $245 co-pay per day for days 1 through 6.
  • No cost to you per day for days 7 through 90.
  • Outpatient group therapy visit: $40 copay
  • Outpatient individual therapy visit: $40 copay
  • Outpatient Rehabilitation Services
  • Cardiac (heart) rehab services (for a maximum of 2 one-hour sessions per day for up to 36 sessions up to 36 weeks): $20 copay
  • Occupational therapy visit: $25 copay
  • Physical therapy and speech and language therapy visit: $25 copay
  • Outpatient Substance Abuse
  • Group therapy visit: $40 copay
  • Individual therapy visit: $40 copay
  • Outpatient Surgery
  • Ambulatory surgical center: $95 copay
  • Outpatient hospital: $195 copay
  • Over-the-Counter Items
  • Not Covered
  • Prosthetic Devices (braces, artificial limbs, etc.)
  • Prosthetic devices: 20% of the cost
  • Related medical supplies: 20% of the cost
  • Renal Dialysis
  • 20% of the cost
  • Transportation
  • Not covered
  • Urgently Needed Care
  • $40 copay
  • If you are admitted to the hospital within 24 hours you do not have to pay your share of the cost for urgent care. See the Inpatient Hospital Care section for other costs.
  • Vision Services
  • Exam to diagnose and treat diseases and conditions of the eye (including yearly glaucoma screening): $0-40 co-pay depending on the service
  • Routine eye exam (for up to 1 every year): No cost to you
  • Contact lenses: No cost to you
  • Eyeglasses (frames and lenses) (for up to 1 every year): No cost to you
  • Eyeglass frames (for up to 1 every year): No cost to you
  • Eyeglass lenses (for up to 1 every year): No cost to you
  • Eyeglasses or contact lenses after cataract surgery: No cost to you
  • Cigna-HealthSpring Advantage pays up to $100 every year for eyewear.

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Hospital Stays

If you are admitted to a hospital or clinic for treatment and stay overnight, you are an inpatient. Most plans have tiered costs for inpatient treatment. Here's how this plan covers you:

  • Cigna-HealthSpring Advantage covers 90 days for an inpatient hospital stay.
  • Cigna-HealthSpring Advantage also covers 60 "lifetime reserve days." These are "extra" days Cigna-HealthSpring Advantage covers. If your hospital stay is longer than 90 days you can use these extra days. But once you have used the 60 extra days your inpatient hospital coverage will be limited to 90 days.
  • $240 co-payment per day for days 1 through 7.
  • You pay nothing per day for days 8 through 90.
  • Cigna-HealthSpring Advantage covers up to 100 days in a Skilled Nursing Facility (SNF).
  • $0 co-payment per day for days 1 through 20.
  • $150 co-payment per day for days 21 through 100.

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Preventive Care

Medicare covers some preventive care services, including cardiovascular screenings, alcohol misuse screening and counseling, depression screen, and diabetes screening. This plan covers preventive services as follows:

  • Preventive Care
  • You pay nothing
  • Cigna-HealthSpring Advantage covers many preventive services including:
    • Abdominal aortic aneurysm screening.
    • Alcohol misuse counseling.
    • Bone mass measurement.
    • Breast cancer screening (mammogram).
    • Cardiovascular disease (behavioral therapy).
    • Cardiovascular screenings.
    • Cervical and vaginal cancer screening.
    • Colonoscopy.
    • Colorectal cancer screenings.
    • Depression screening.
    • Diabetes screenings.
    • Fecal occult blood test.
    • Flexible sigmoidoscopy.
    • HIV screening.
    • Medical nutrition therapy services.
    • Obesity screening and counseling.
    • Prostate cancer screenings (PSA).
    • Sexually transmitted infections screening and counseling.
    • Tobacco use cessation counseling (counseling for people with no sign of tobacco-related disease) .
    • Vaccines including Flu shots Hepatitis B shots Pneumococcal shots.
    • Welcome to Medicare preventive visit (one-time checkup).
    • Yearly Wellness visit.
  • All other preventive healthcare services approved by Medicare during the contract year will be covered.

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Prescription Drug Coverage

This plan does not include Medicare Part D prescription drug coverage. If you enroll in this plan you will need to choose a stand-alone Part D plan. The following stand-alone plans are available in Alabama:

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Medicare Plan Rating

Medicare gave the Cigna-HealthSpring Advantage plan an average rating of 3.0 out of 5 stars. This rating is Average, by Medicare's definition.

Each Medicare Advantage plan receives a 1.0 to 5.0 star rating by Medicare (annually). The quality assessment of plans helps people considering enrollment. A plan with 5 stars has the highest quality.

Compare Plans

Compare Cigna-HealthSpring Advantage with these top rated plans available in Lauderdale County:

Cigna-HealthSpring Advantage Availability

Cigna-HealthSpring Advantage is available in Florence, Waterloo, Lexington, Cloverdale, Rogersville, Anderson, Killen, and all other areas of Lauderdale County.

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This page was last updated on 10/12/2015.