Senior Care Plus: Freedom Rx Plan Carson City County, Nevada 2016 Medicare Advantage Plan H2906-007

PPO Plan
$52.00
5-Star Rating:{plan}, a Medicare Advantage plan available in Carson City County, NV, an average Medicare rating of 3.0 out of 5 stars.
Plan ID:H2906-007
Plan Year:2016
Full Premium:$52.00/mo
Annual MOOP:$3,400
Part D Benefit:Yes
Rx Deductible:$0.00/year
Rx Gap Coverage:No
Online Pharmacy:No
Plan Phone #:888-775-7003
Summary of Benefits:Not Available

Senior Care Plus: Freedom Rx Plan Medicare Advantage Plan for Carson City County, Nevada seniors on Medicare.Senior Care Plus: Freedom Rx Plan is a Preferred Provider Organization Medicare Advantage Plan, by Hometown Health, available in Carson City County, NV. It gives you freedom to choose your doctors, specialists and hospital facilities. Plus, you can keep your out of pocket costs as low as possible when you use the Hometown Health network. You get predictable copayments and coinsurance, making it easier to keep your healthcare costs in check.

Monthly Premium

The monthly premium for this plan in Carson City County, NV is $52.00. This amount is paid directly to Hometown Health.

This plan has a monthly premium because its cost is not full covered by the Medicare Part B premium. When you enroll in this plan, Social Security will continue to deduct Medicare Part B from your monthly payment. If you do not pay a penalty due to late enrollment penalty and your income is less than $85k ($170k for married couples) you'll pay the standard Medicare 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.

What you pay in premiums is independent of the health care services you use. You also have copayments and/or coinsurances (cost sharing) that you pay out of pocket when you use health care services or fill prescriptions.

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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 Senior Care Plus: Freedom Rx Plan 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
  • For up to 10 visit(s) every year:
  • In-network: $25 co-pay .
  • Out-of-network: $40 copay.
  • Ambulance Services
  • In-network: $250 copay.
  • Out-of-network: 30% of the cost.
  • Chiropractic Care
  • Manipulation of the spine to correct a subluxation (when 1 or more of the bones of your spine move out of position):
  • In-network: $20 copay.
  • Out-of-network: $40 copay.
  • Dental Services
  • Limited dental services (this does not include services in connection with care treatment filling removal or replacement of teeth):
  • In-network: $45 copay.
  • Out-of-network: 30% of the cost.
  • Diabetes Supplies and Services
  • Diabetes monitoring supplies:
  • In-network: 0-20% of the cost depending on the supply.
  • Out-of-network: 30% of the cost.
  • Diabetes self-management training:
  • In-network: No cost to you.
  • Out-of-network: 30% of the cost.
  • Therapeutic shoes or inserts:
  • In-network: 20% of the cost.
  • Out-of-network: 30% of the cost.
  • Diagnostic Tests, Lab and Radiology Services, and X-Rays
  • Diagnostic radiology services (such as MRIs CT scans):
  • In-network: $90-120 co-pay depending on the service.
  • Out-of-network: 30% of the cost.
  • Diagnostic tests and procedures:
  • In-network: $0-120 co-pay depending on the service.
  • Out-of-network: 30% of the cost.
  • Lab services:
  • In-network: $0-120 co-pay depending on the service.
  • Out-of-network: 30% of the cost.
  • Outpatient x-rays:
  • In-network: $60 copay.
  • Out-of-network: 30% of the cost.
  • Therapeutic radiology services (such as radiation treatment for cancer):
  • In-network: $60 copay.
  • Out-of-network: 30% of the cost.
  • Doctor's Office Visits
  • Primary care physician visit:
  • In-network: $20 copay.
  • Out-of-network: $30 copay.
  • Specialist visit:
  • In-network: $45 copay.
  • Out-of-network: $70 copay.
  • Durable Medical Equipment (wheelchairs, oxygen, etc.)
  • In-network: 20% of the cost .
  • Out-of-network: 30% 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 immediately admitted to the hospital 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:
  • In-network: $45 copay.
  • Out-of-network: $70 copay.
  • Hearing Services
  • Exam to diagnose and treat hearing and balance issues:
  • In-network: $45 copay.
  • Out-of-network: 30% of the cost.
  • Home Health Care
  • In-network: No cost to you.
  • Out-of-network: 30% of the cost.
  • Mental Health Care
  • Inpatient visit:
  • Senior Care Plus: Freedom Rx Plan 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.
  • Senior Care Plus: Freedom Rx Plan covers 90 days for an inpatient hospital stay.
  • Senior Care Plus: Freedom Rx Plan also covers 60 lifetime reserve days. These are extra days Senior Care Plus: Freedom Rx Plan 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.
  • :
  • In-Network:/strong>
  • $300 co-pay per day for days 1 through 4.
  • No cost to you per day for days 5 through 90.
  • :
  • Out-of-Network:
  • $500 co-pay or 30% of the cost per stay depending on the service.
  • Outpatient group therapy visit:
  • In-network: $40 copay.
  • Out-of-network: $70 copay.
  • Outpatient individual therapy visit:
  • In-network: $40 copay.
  • Out-of-network: $70 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):
  • In-network: $15 copay.
  • Out-of-network: 30% of the cost.
  • Occupational therapy visit:
  • In-network: $25 copay.
  • Out-of-network: 30% of the cost.
  • Physical therapy and speech and language therapy visit:
  • In-network: $25 copay.
  • Out-of-network: 30% of the cost.
  • Outpatient Substance Abuse
  • Group therapy visit:
  • In-network: $45 copay.
  • Out-of-network: 30% of the cost.
  • Individual therapy visit:
  • In-network: $45 copay.
  • Out-of-network: 30% of the cost.
  • Outpatient Surgery
  • Ambulatory surgical center:
  • In-network: $300 copay.
  • Out-of-network: 30% of the cost.
  • Outpatient hospital:
  • In-network: $0-300 co-pay depending on the service .
  • Out-of-network: 30% of the cost.
  • Over-the-Counter Items
  • Visit the plan's website to see their list of covered over-the-counter items.
  • Prosthetic Devices (braces, artificial limbs, etc.)
  • Prosthetic devices:
  • In-network: 20% of the cost.
  • Out-of-network: 30% of the cost.
  • Related medical supplies:
  • In-network: 20% of the cost.
  • Out-of-network: 30% of the cost.
  • Renal Dialysis
  • In-network: 20% of the cost .
  • Out-of-network: 30% of the cost.
  • Transportation
  • In-network: No cost to you.
  • Out-of-network: No cost to you.
  • Urgently Needed Care
  • $30-60 co-pay depending on the service
  • If you are immediately admitted to the hospital 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):
  • In-network: $0-20 co-pay depending on the service.
  • Out-of-network: 30% of the cost.
  • Routine eye exam (for up to 1 every year):
  • In-network: $20 co-pay .
  • Out-of-network: $0-20 co-pay depending on the service.
  • Senior Care Plus: Freedom Rx Plan pays up to $54 every year for routine eye exams from an in-network provider and an additional $54 every year from an out-of-network provider.
  • Contact lenses (for up to 1 every two years):
  • In-network: No cost to you.
  • Out-of-network: 30% of the cost.
  • Senior Care Plus: Freedom Rx Plan pays up to $100 every two years for contact lenses from an in-network provider and an additional $100 every two years from an out-of-network provider.
  • Eyeglasses frames (for up to 1 every two years):
  • In-network: No cost to you.
  • Out-of-network: 30% of the cost.
  • Senior Care Plus: Freedom Rx Plan pays up to $100 every two years for eyeglass frames from an in-network provider and an additional $100 every two years from an out-of-network provider.
  • Eyeglasses lenses (for up to 1 every two years):
  • In-network: No cost to you.
  • Out-of-network: 30% of the cost.
  • Eyeglasses or contact lenses after cataract surgery:
  • In-network: 20% of the cost.
  • Out-of-network: 30% of the cost.

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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:

  • Senior Care Plus: Freedom Rx Plan covers an unlimited number of days for an inpatient hospital stay.
  • In-network:  .
  • $300 co-payment per day for days 1 through 4.
  • You pay nothing per day for days 5 through 90.
  • You pay nothing per day for days 91 and beyond.
  • Out-of-network:  .
  • $500 co-payment or 30% of the cost per stay depending on the service.
  • Senior Care Plus: Freedom Rx Plan covers up to 100 days in a Skilled Nursing Facility (SNF).
  • In-network:  .
  • $40 co-payment per day for days 1 through 20.
  • $150 co-payment per day for days 21 through 34.
  • $0 co-payment per day for days 35 through 100.
  • Out-of-network:  .
  • 30% of the cost per stay.

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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
    • >In-Network: You pay nothing.
    • Out-of-Network: 30% of the cost.
  • Senior Care Plus: Freedom Rx Plan 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 (00015426) has a total of 3,243 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:1951921364332411
  — Cost-Sharing in ICP:$6.00$14.00$45.00$95.0033%

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

The Part D deductible on this plan is $0.00 (first dollar coverage).

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Medicare Plan Rating

Medicare gave the Senior Care Plus: Freedom Rx Plan plan an average rating of 3.0 out of 5 stars. This rating is 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 Senior Care Plus: Freedom Rx Plan with these top rated plans available in Carson City County:

Senior Care Plus: Freedom Rx Plan Availability

Senior Care Plus: Freedom Rx Plan is available in Carson City, and all other areas of Carson City County.

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