EmblemHealth Essential for Richmond, NY
|Part C Premium:|
|Part D Deductible:||$0.00|
|Gap Coverage:||No Gap Coverage|
|Residents of:||NY Residents|
|Plan Type:||Local HMO|
Medicare Advantage 2014 Plan Summary
EmblemHealth Essential (H3330-032) is a Health Maintenance Organization (HMO) Advantage plan for seniors and other Medicare beneficiaries in the county of Richmond, New York. The healthcare plan includes all of the coverage benefits of Medicare Part A and Part B, and may include Part D coverage for prescriptions, as well as other extras. The benefit of an HMO plan like this one is that the out-of-pocket costs are lower and more predictable than with other types of plans private insurance or your Original Medicare.
An HMO is not as flexible as your Original Medicare. You are required to use the insurance carrier's network of providers. If you use a healthcare provider outside of the network, you are responsible for the costs. In most cases, you must get a referral from your primary care physician to see specialists.
The plan information presented on this page is a summary, but not a complete description of available benefits. Comprehensive information about the plan benefits is available from your agent.
The monthly premium for this healthcare plan is $0.00 plus your monthly Medicare Part B premium. Most Medicare Beneficiaries pay the standard monthly Part B premium in addition to their MA or MAPD plan premium. However, some beneficiaries are required to pay slightly higher Part B and Part D premiums because of their income (over $85,000 per year for singles or $170,000 for married couples), or due to late enrollment penalties.
Summary of Benefits
NOTE: As of this publication date the Summary of Benefits information for this 2014 plan was not available from CMS. Please Contact an Agent and ask for the Summary of Benefits document.
Part D Plan Information
The Part D deductible for this plan is $0.00. That means you have first dollar coverage.
Maximum Out of Pocket (MOOP) Benefit
The new Affordable Care Act (aka, ObamaCare) law placed a mandatory maximum limit of $6,700 on all out of pocket medical costs for 2014 Medicare Advantage plans, which is referred to as the Maximum Out of Pocket or MOOP. The MOOP does not include prescriptions and monthly premiums. The Mandatory MOOP is $6,700 but the Affordable Care Act allows for a “Voluntary MOOP” as low as $3,400. The MOOP with this health plan is $3,400
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