2021 Amerivantage Dual Coordination Plus (HMO D-SNP)

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This is archive material for research purposes. Please see PDPFinder.com or MAFinder.com for current plans. 2021 Amerivantage Dual Coordination Plus (HMO D-SNP) in Harris, Texas
Medicare Advantage Plan Benefit Details in Plain Text
The following Medicare Advantage plan benefits apply to the Amerivantage Dual Coordination Plus (HMO D-SNP) (H8849 - 010) in Harris, Texas . This plan is administered by . To switch to a different Medicare Advantage plan or to change your location, click here.
Click here to see the Amerivantage Dual Coordination Plus (HMO D-SNP) health and prescription benefit details in chart format or email and view benefits chart
Plan Premium
The Amerivantage Dual Coordination Plus (HMO D-SNP) has a monthly premium of $22.50. That is $270.00 for 12 months. There are a few factors that can increase or decrease this premium. If you qualify for full or partial extra help, your premium will be lower. If you have a premium penalty, your premium will be higher. Please remember that the $22.50 montly premium is in addition to your Medicare Part B premium. If you have a premium penalty, your premium will be higher. Or if you have a higher income you would be subject to the Income Related Adjustment Amount (IRMAA).
This Medicare Advantage Plan with Prescription Drug Coverage is a Local HMO plan.
Plan Membership
The Amerivantage Dual Coordination Plus (HMO D-SNP) (H8849 - 010) currently has 24,733 members. There are 9,205 members enrolled in this plan in Harris, Texas.
Prescription Drug Coverage: Deductible, Cost-sharing, Formulary
This plan has a $445 deductible. However, formulary drugs on Tier 1 are excluded from the $445 deductible and have first dollar coverage (or a $0 deductible). So, you are 100% responsible for the first $445 in medication costs for drugs not on the excluded tiers. After you have met the deductible, the Amerivantage Dual Coordination Plus (HMO D-SNP) will share the costs of your medications with you -- see cost-sharing below. $445 is the maximum deductible for 2021. There are other plans with a lower deductible or even a $0 deductible for all formulary drugs. Click here to review plans with a $0 deductible.
The following information is about the Amerivantage Dual Coordination Plus (HMO D-SNP) formulary (or drug list). There are 3639 drugs on the Amerivantage Dual Coordination Plus (HMO D-SNP) formulary. Click here to browse the Amerivantage Dual Coordination Plus (HMO D-SNP) Formulary.
The Initial Coverage Phase (ICP) can be thought of as the cost-sharing phase of the plan. During this phase, you and the insurance company share your prescription costs. Once you have spent $445, your initial coverage phase will start. All medication are divided into tiers within the plans formulary. This helps the plan to organize and manage the prescription cost-sharing. The Amerivantage Dual Coordination Plus (HMO D-SNP)’s formulary is divided into 6 tiers. Every plan can name their tiers differently, and can place medications on any tier. The cost-sharing for this plan is divided as follows:
  • Tier 1 (Preferred Generic) contains 0 drugs and has a co-payment of $0.00.
  • Tier 2 (Generic) contains 0 drugs and has a co-payment of $14.00.
  • Tier 3 (Preferred Brand) contains 0 drugs and has a co-payment of $47.00.
  • Tier 4 (Non-Preferred Drug) contains 0 drugs and has a co-payment of $95.00.
  • Tier 5 (Specialty Tier) contains 0 drugs and has a co-insurance of 25% of the drug cost.
  • Tier 6 (Select Care Drugs) contains drugs and has a co-payment of $0.00.
Click here to browse the Amerivantage Dual Coordination Plus (HMO D-SNP) Formulary.
The Coverage Gap, which is also known as the Donut (Doughnut) Hole is the phase of your Medicare Part D plan where you are responsible for 100% of your medication costs. Healthcare Reform mandates that the insurance carrier pay 75% of your generic drug prescription costs in the donut hole on your behalf. The brand-name drug manufacturer will pay 70% and your plan will pay an additional 5% of the cost of your brand-name drugs purchased in the Donut Hole, for a total of 75% discount. The 70% paid by the brand-name drug manufacturer is paid on your behalf and therefore counts toward your TrOOP (or True Out-of-Pocket) costs. The portion paid by your plan, does not count toward TrOOP. Some Medicare Part D plans offer coverage during the Coverage Gap that is beyond the mandated discounts. Any drug not covered by the plan’s Gap Coverage will still receive the discounts noted above -- even if the plan has "No Gap Coverage". This plan (Amerivantage Dual Coordination Plus (HMO D-SNP)) offers Coverage in the gap, however Medicare has not specified the details of the gap coverage.
The Amerivantage Dual Coordination Plus (HMO D-SNP) offers many Health and Prescription Drug Coverage Benefits. The following section will describe these benefits in detail.
** Base Plan **
Premium
• Health plan premium: $0
• Drug plan premium: $0
• You must continue to pay your Part B premium.
• Part B premium reduction: No
Deductible
• Health plan deductible: $0
• Other health plan deductibles: In-network: No
• Drug plan deductible: $445.00 annual deductible
Maximum out-of-pocket enrollee responsibility (does not include prescription drugs)
• $7,550 In-network
Optional supplemental benefits
• No
Additional benefits and/or reduced cost-sharing for enrollees with certain health conditions?
• In-network: No
Doctor visits
• Primary: $0 copay
• Specialist: $0 copay (authorization and referral required)
Diagnostic procedures/lab services/imaging
• Diagnostic tests and procedures: $0 copay (authorization and referral required)
• Lab services: $0 copay (authorization and referral required)
• Diagnostic radiology services (e.g., MRI): $0 copay (authorization and referral required)
• Outpatient x-rays: $0 copay (authorization and referral required)
Emergency care/Urgent care
• Emergency: $0 copay
• Urgent care: $0 copay
Inpatient hospital coverage
• $0 copay (authorization required)
Outpatient hospital coverage
• $0 copay (authorization and referral required)
Skilled Nursing Facility
• $0 copay (authorization required)
Preventive care
• $0 copay
Ground ambulance
• $0 copay
Rehabilitation services
• Occupational therapy visit: $0 copay (authorization and referral required)
• Physical therapy and speech and language therapy visit: $0 copay (authorization and referral required)
Mental health services
• Inpatient hospital - psychiatric: $0 copay (authorization required)
• Outpatient group therapy visit with a psychiatrist: $0 copay (authorization and referral required)
• Outpatient individual therapy visit with a psychiatrist: $0 copay (authorization and referral required)
• Outpatient group therapy visit: $0 copay (authorization and referral required)
• Outpatient individual therapy visit: $0 copay (authorization and referral required)
Medical equipment/supplies
• Durable medical equipment (e.g., wheelchairs, oxygen): $0 copay (authorization required)
• Prosthetics (e.g., braces, artificial limbs): $0 copay (authorization required)
• Diabetes supplies: $0 copay (authorization required)
Hearing
• Hearing exam: $0 copay (authorization and referral required)
• Fitting/evaluation: $0 copay (limits apply, authorization and referral required)
• Hearing aids: $0 copay (limits apply, authorization required)
Preventive dental
• Oral exam: $0 copay (limits apply)
• Cleaning: $0 copay (limits apply)
• Fluoride treatment: $0 copay (limits apply)
• Dental x-ray(s): $0 copay (limits apply)
Comprehensive dental
• Non-routine services: $0 copay (limits apply)
• Diagnostic services: $0 copay (limits apply)
• Restorative services: $0 copay (limits apply)
• Endodontics: $0 copay (limits apply)
• Periodontics: $0 copay (limits apply)
• Extractions: $0 copay (limits apply)
• Prosthodontics, other oral/maxillofacial surgery, other services: $0 copay (limits apply)
Vision
• Routine eye exam: $0 copay (limits apply)
• Other: Not covered
• Contact lenses: $0 copay (limits apply)
• Eyeglasses (frames and lenses): $0 copay (limits apply)
• Eyeglass frames: $0 copay (limits apply)
• Eyeglass lenses: $0 copay (limits apply)
• Upgrades: Not covered
Wellness programs (e.g., fitness, nursing hotline)
• Covered (authorization required)
Transportation
• $0 copay (limits apply, authorization required)
Foot care (podiatry services)
• Foot exams and treatment: $0 copay (authorization and referral required)
• Routine foot care: $0 copay (authorization and referral required)
Medicare Part B drugs
• Chemotherapy: $0 copay (authorization required)
• Other Part B drugs: $0 copay (authorization required)

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