Care Improvement Plus Medicare Advantage Polk County, Missouri 2016 Medicare Advantage Plan H6528-006

PPO Plan
$49.00
5-Star Rating:{plan}, a Medicare Advantage plan available in Polk County, MO, an average Medicare rating of 2.0 out of 5 stars.
Plan ID:H6528-006
Plan Year:2016
Full Premium:$49.00/mo
Annual MOOP:$6,700
Part D Benefit:Yes
Rx Deductible:$100.00/year
Rx Gap Coverage:No
Online Pharmacy:No
Plan Phone #:855-633-4198
Summary of Benefits: Care Improvement Plus Medicare Advantage Medicare Advantage Plan H6528-006 Summary of Benefits for Polk County, Missouri

Care Improvement Plus Medicare Advantage Medicare Advantage Plan for Polk County, Missouri seniors on Medicare.Care Improvement Plus Medicare Advantage is a Preferred Provider Organization Medicare Advantage Plan, by Care Improvement Plus, available in Polk County, MO. 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 Care Improvement Plus 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 Polk County, MO is $49.00. This amount is paid directly to Care Improvement Plus.

This plan has a monthly premium, but it isn't the full cost. The plan's premium is in addition to your Medicare Part B premium. If your income is over $85,000 ($170,000 for married couples), or you have a penalty due to late enrollment, you'll 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

There is a maximum out of pocket limit of $6,700 on your healthcare costs in 2016. This is commonly called the plan MOOP. The MOOP does not include your prescriptions or your monthly premium.

Although the mandatory MOOP limit is $6,700, Medicare allows for a lower “Voluntary MOOP” that can be as low as $3,400. This plan's MOOP is $6,700. Take this figure into as much consideration along with the premium and the copay.

If you are comparing this plan with Original Medicare, factor in that there are no out-of-pocket limits on Medicare Parts A and B. With Original Medicare you'll need a Medicare Supplement to cover what the government doesn't.

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Coverage, Copayments & Coinsurance

The Care Improvement Plus Medicare 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
  • In-network: $250 copay.
  • Out-of-network: $250 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):
  • In-network: $20 copay.
  • Out-of-network: $20 copay.
  • Dental Services
  • Limited dental services (this does not include services in connection with care treatment filling removal or replacement of teeth):
  • In-network: $50 copay.
  • Out-of-network: $50 copay.
  • A single office visit that includes:
  • Cleaning (for up to 1 every year).
  • Dental x-ray(s) (for up to 1 every year).
  • Oral exam (for up to 1 every year).
  • In-network: $20 co-pay .
  • Out-of-network: $20 copay.
  • Diabetes Supplies and Services
  • Diabetes monitoring supplies:
  • In-network: No cost to you.
  • Out-of-network: 20% of the cost.
  • Diabetes self-management training:
  • In-network: No cost to you.
  • Out-of-network: No cost to you.
  • Therapeutic shoes or inserts:
  • In-network: 20% of the cost.
  • Out-of-network: 20% of the cost.
  • Diagnostic Tests, Lab and Radiology Services, and X-Rays
  • Diagnostic radiology services (such as MRIs CT scans):
  • In-network: 20% of the cost.
  • Out-of-network: $13-15 co-pay or 20% of the cost depending on the service.
  • Diagnostic tests and procedures:
  • In-network: 20% of the cost.
  • Out-of-network: $13-15 co-pay or 20% of the cost depending on the service.
  • Lab services:
  • In-network: $13 copay.
  • Out-of-network: $13-15 co-pay or 20% of the cost depending on the service.
  • Outpatient x-rays:
  • In-network: $15 copay.
  • Out-of-network: $13-15 co-pay or 20% of the cost depending on the service.
  • Therapeutic radiology services (such as radiation treatment for cancer):
  • In-network: 20% of the cost.
  • Out-of-network: $13-15 co-pay or 20% of the cost depending on the service.
  • Doctor's Office Visits
  • Primary care physician visit:
  • In-network: $30 copay.
  • Out-of-network: $30 copay.
  • Specialist visit:
  • In-network: $50 copay.
  • Out-of-network: $50 copay.
  • Durable Medical Equipment (wheelchairs, oxygen, etc.)
  • In-network: 20% of the cost .
  • Out-of-network: 40% 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:
  • In-network: $50 copay.
  • Out-of-network: $50 copay.
  • Routine foot care (for up to 6 visit(s) every year):
  • In-network: $50 co-pay .
  • Out-of-network: $50 copay.
  • Hearing Services
  • Exam to diagnose and treat hearing and balance issues:
  • In-network: $50 copay.
  • Out-of-network: $50 copay.
  • Routine hearing exam (for up to 1 every year):
  • In-network: $30 co-pay .
  • Out-of-network: $30 copay.
  • Hearing aid:
  • In-network: $330-380 co-pay for each hearing aid depending on the type.
  • Out-of-network: $330-380 co-pay for each hearing aid depending on the type.
  • Home Health Care
  • In-network: No cost to you.
  • Out-of-network: 50% of the cost.
  • Mental Health Care
  • Inpatient visit:
  • Care Improvement Plus Medicare 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.
  • Care Improvement Plus Medicare Advantage covers 90 days for an inpatient hospital stay.
  • Care Improvement Plus Medicare Advantage also covers 60 lifetime reserve days. These are extra days Care Improvement Plus Medicare 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.
  • :
  • In-Network:/strong>
  • $395 co-pay per day for days 1 through 3.
  • No cost to you per day for days 4 through 90.
  • :
  • Out-of-Network:
  • $395 co-pay per day for days 1 through 3.
  • No cost to you per day for days 4 through 90.
  • Outpatient group therapy visit:
  • In-network: $30 copay.
  • Out-of-network: $30-40 co-pay depending on the service.
  • Outpatient individual therapy visit:
  • In-network: $40 copay.
  • Out-of-network: $30-40 co-pay depending on the service.
  • 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: $50 copay.
  • Out-of-network: $50 copay.
  • Occupational therapy visit:
  • In-network: $40 copay.
  • Out-of-network: $30-40 co-pay depending on the service.
  • Physical therapy and speech and language therapy visit:
  • In-network: $40 copay.
  • Out-of-network: $30-40 co-pay depending on the service.
  • Outpatient Substance Abuse
  • Group therapy visit:
  • In-network: $30 copay.
  • Out-of-network: $30-40 co-pay depending on the service.
  • Individual therapy visit:
  • In-network: $40 copay.
  • Out-of-network: $30-40 co-pay depending on the service.
  • Outpatient Surgery
  • Ambulatory surgical center:
  • In-network: 20% of the cost .
  • Out-of-network: 20% of the cost.
  • Outpatient hospital:
  • In-network: 20% of the cost .
  • Out-of-network: 20% of the cost.
  • Over-the-Counter Items
  • Not Covered
  • Prosthetic Devices (braces, artificial limbs, etc.)
  • Prosthetic devices:
  • In-network: 20% of the cost.
  • Out-of-network: 20% of the cost.
  • Related medical supplies:
  • In-network: 20% of the cost.
  • Out-of-network: 20% of the cost.
  • Renal Dialysis
  • In-network: 20% of the cost .
  • Out-of-network: 20% of the cost.
  • Transportation
  • Not covered
  • Urgently Needed Care
  • $30-40 co-pay depending on the service
  • Vision Services
  • Exam to diagnose and treat diseases and conditions of the eye (including yearly glaucoma screening):
  • In-network: $0-50 co-pay depending on the service.
  • Out-of-network: $0-50 co-pay depending on the service.
  • Routine eye exam (for up to 1 every year):
  • In-network: $25 co-pay .
  • Out-of-network: $25 copay.
  • Contact lenses:
  • In-network: No cost to you.
  • Out-of-network: No cost to you.
  • Eyeglasses (frames and lenses):
  • In-network: No cost to you.
  • Out-of-network: No cost to you.
  • Eyeglasses or contact lenses after cataract surgery:
  • In-network: No cost to you.
  • Out-of-network: No cost to you.
  • Care Improvement Plus Medicare Advantage pays up to $100 every year for contact lenses and eyeglasses (frames and lenses) from any provider.

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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:

  • Care Improvement Plus Medicare Advantage covers an unlimited number of days for an inpatient hospital stay.
  • In-network:  .
  • $395 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:  .
  • $395 co-payment per day for days 1 through 4.
  • You pay nothing per day for days 5 and beyond.
  • Care Improvement Plus Medicare Advantage covers up to 100 days in a Skilled Nursing Facility (SNF).
  • In-network:  .
  • You pay nothing per day for days 1 through 20.
  • $155 co-payment per day for days 21 through 64.
  • You pay nothing per day for days 65 through 100.
  • Out-of-network:  .
  • You pay nothing per day for days 1 through 20.
  • $155 co-payment per day for days 21 through 64.
  • You pay nothing per day for days 65 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
    • >In-Network: You pay nothing.
    • Out-of-Network: You pay nothing.
  • Care Improvement Plus Medicare 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 includes Medicare Part D coverage for your prescription medications. The formulary (00015004) has a total of 3,649 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:3105699601130680
  — Cost-Sharing in ICP:$3.00$12.00$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 plan is $100.00. 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 Care Improvement Plus Medicare Advantage plan an average rating of 2.0 out of 5 stars. This rating is Below 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 Care Improvement Plus Medicare Advantage with these top rated plans available in Polk County:

Care Improvement Plus Medicare Advantage Availability

Care Improvement Plus Medicare Advantage is available in Fair Play, Aldrich, Flemington, Brighton, Humansville, Dunnegan, Half Way, Polk, Eudora, Morrisville, Bolivar, and all other areas of Polk County.

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