CCHP Senior Program San Francisco County, California 2016 Medicare Advantage Plan H0571-001

HMO Plan
5-Star Rating:{plan}, a Medicare Advantage plan available in San Francisco County, CA, an average Medicare rating of 4.0 out of 5 stars.
Plan ID:H0571-001
Plan Year:2016
Full Premium:$46.00/mo
Annual MOOP:$3,400
Part D Benefit:Yes
Rx Deductible:$360.00/year
Rx Gap Coverage:No
Online Pharmacy:No
Plan Phone #:888-775-7888
Summary of Benefits:Not Available

CCHP Senior Program Medicare Advantage Plan for San Francisco County, California seniors on Medicare.CCHP Senior Program is a Health Maintenance Organization (HMO) Medicare Advantage plan, by Chinese Community Health Plan, available in San Francisco County, California. It offers all of the basic benefits of Original Medicare and may include additional coverage.

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

IMPORTANT: You must use providers in the Chinese Community Health Plan 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

The monthly premium for this plan in San Francisco County, CA is $46.00. This amount is paid directly to Chinese Community Health Plan.

If you enroll in this plan you will pay your Medicare Part B premium plus this plan's monthly premium. Most people pay the standard Part B premium, but some beneficiaries pay higher Part B premiums due to their annual income (over $85k for singles or $170k for married couples). Late enrollment penalties can also increase your 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 $3,400. 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 $3,400. 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 CCHP Senior Program 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
  • $25 copay
  • Ambulance Services
  • $175 copay
  • Chiropractic Care
  • Manipulation of the spine to correct a subluxation (when 1 or more of the bones of your spine move out of position): $15 copay
  • Dental Services
  • Limited dental services (this does not include services in connection with care treatment filling removal or replacement of teeth): $15 copay
  • Diabetes Supplies and Services
  • Diabetes monitoring supplies: No cost to you
  • Diabetes self-management training: No cost to you
  • Therapeutic shoes or inserts: No cost to you
  • 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: No cost to you
  • Lab services: No cost to you
  • Outpatient x-rays: No cost to you
  • Therapeutic radiology services (such as radiation treatment for cancer): No cost to you
  • Doctor's Office Visits
  • Primary care physician visit: $15 copay
  • Specialist visit: $15 copay
  • Durable Medical Equipment (wheelchairs, oxygen, etc.)
  • 20% of the cost
  • If you go to a preferred vendor your cost may be less. Contact us for a list of preferred vendors.
  • 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: $35 copay
  • Hearing Services
  • Exam to diagnose and treat hearing and balance issues: $35 copay
  • Routine hearing exam (for up to 1 every year): $35 copay
  • Home Health Care
  • No cost to you
  • Mental Health Care
  • Inpatient visit:
  • CCHP Senior Program 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.
  • CCHP Senior Program covers 90 days for an inpatient hospital stay.
  • CCHP Senior Program also covers 60 lifetime reserve days. These are extra days CCHP Senior Program 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.
  • $250 co-pay per day for days 1 through 7.
  • No cost to you per day for days 8 through 90.
  • Outpatient group therapy visit: $35 copay
  • Outpatient individual therapy visit: $35 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): $35 copay
  • Occupational therapy visit: $35 copay
  • Physical therapy and speech and language therapy visit: $35 copay
  • Outpatient Substance Abuse
  • Group therapy visit: $35 copay
  • Individual therapy visit: $35 copay
  • Outpatient Surgery
  • Ambulatory surgical center: $195-295 co-pay depending on the service
  • Outpatient hospital: $195-295 co-pay depending on the service
  • 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
  • No cost to you
  • Transportation
  • Not covered
  • Urgently Needed Care
  • $15 copay
  • Vision Services
  • Exam to diagnose and treat diseases and conditions of the eye (including yearly glaucoma screening): $35 copay
  • Routine eye exam (for up to 1 every year): $35 copay
  • Eyeglasses (frames and lenses) (for up to 1 every two years): No cost to you
  • Eyeglasses or contact lenses after cataract surgery: No cost to you
  • CCHP Senior Program pays up to $80 every two years for eyeglasses (frames and lenses).

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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:

  • CCHP Senior Program covers an unlimited number of days for an inpatient hospital stay.
  • Your costs may vary depending on your hospital's tier (or group).
  • Tier 1
  • $200 co-payment per day for days 1 through 7.
  • You pay nothing per day for days 8 through 90.
  • You pay nothing per day for days 91 and beyond.
  • Tier 2
  • $300 co-payment per day for days 1 through 7.
  • You pay nothing per day for days 8 through 90.
  • You pay nothing per day for days 91 and beyond.
  • CCHP Senior Program covers up to 100 days in a Skilled Nursing Facility (SNF).
  • $0 co-payment per day for days 1 through 20.
  • $135 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
  • CCHP Senior Program 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 includes Medicare Part D coverage for your prescription medications. The formulary (00015184) has a total of 5,134 prescription medications. The table below outlines what you will pay (the copayment) at your pharmacy for medications at each tier level.

Formulary Drug Details:Tier 1Tier 2Tier 3Tier 4Tier 5
  — Drugs per Tier:10221576871853335
  — Cost-Sharing in ICP:$3.00$7.00$40.00$60.0020%

If you are entitled to Part D assistance, your premium will be adjusted based on your percentage.

The Part D deductible on plan is $360.00. This is the amount you will pay until the plan begins to pay its portion.

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Medicare Plan Rating

Medicare gave the CCHP Senior Program plan an average rating of 4.0 out of 5 stars. This rating is Above Average, by Medicare's definition.

Medicare rates the quality of all Medicare Advantage plans. Ratings help shopper considering enrollment. Five stars represents the best quality. Plans rated less than 2.5 stars cannot be sold.

Compare Plans

Compare CCHP Senior Program with these top rated plans available in San Francisco County:

CCHP Senior Program Availability

CCHP Senior Program is available in San Francisco, and all other areas of San Francisco County.

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