Maricopa Care Advantage (HMO SNP) Benefits

Maricopa Care Advantage | HMO
Plan website: www.mcareaz.com
Plan Phone Number: (877) 874-3938
U.S. News Preferred Broker Phone: (888) 245-3931
This is a Special Needs Plan (SNP). You can enroll in this plan if you qualify – call the Plan Phone Number at (877) 874-3938 for more information.

This plan may not be available near you. Entering your ZIP Code helps ensure you find plans available in your county.

 

Inpatient Care

Hospital Care

Plan covers 90 days each benefit period.

You will not be charged additional cost sharing for professional services.

Except in an emergency your doctor must tell the plan that you are going to be admitted to the hospital.

Outpatient Care

Doctor Office Visits

Authorization rules may apply.

0% or 20% of the cost for each Medicare-covered primary care doctor visit.*

0% or 20% of the cost for each Medicare-covered specialist visit.*

Doctor and Hospital Choice

You must go to network doctors specialists and hospitals.

Referral required for network hospitals and specialists (for certain benefits).

Diagnostic Tests, X-Rays, Lab Services and Radiology Services

Authorization rules may apply.

0% of the cost for Medicare-covered lab services*

0% or 20% of the cost for Medicare-covered diagnostic procedures and tests*

0% or 20% of the cost for Medicare-covered X-rays*

0% or 20% of the cost for Medicare-covered diagnostic radiology services (not including X-rays)*

0% or 20% of the cost for Medicare-covered therapeutic radiology services*

Emergency Care

0% or 20% of the cost (up to $65) for Medicare-covered emergency room visits*

Not covered outside the U.S. and its territories except under limited circumstances. Contact plan for details.

If you are admitted to the hospital within 3-day(s) for the same condition you pay $0 for the emergency room visit.

Durable Medical Equipment

Authorization rules may apply.

0% or 20% of the cost for Medicare-covered durable medical equipment*

Diabetes Programs and Supplies

Authorization rules may apply.

0% or 20% of the cost for Medicare-covered Diabetes self-management training*

0% or 20% of the cost for Medicare-covered Diabetes monitoring supplies*

0% or 20% of the cost for Medicare-covered Therapeutic shoes or inserts*

Ambulance Services

Authorization rules may apply.

0% or 20% of the cost for Medicare-covered ambulance benefits.*

Urgently Needed Care

0% or 20% of the cost for Medicare-covered urgently-needed-care visits*

Outpatient Services

Authorization rules may apply.

0% or 20% of the cost for each Medicare-covered ambulatory surgical center visit*

0% or 20% of the cost for each Medicare-covered outpatient hospital facility visit*

Chiropractic Services

Authorization rules may apply.

0% or 20% of the cost for each Medicare-covered chiropractic visit*

Medicare-covered chiropractic visits are for manual manipulation of the spine to correct subluxation (a displacement or misalignment of a joint or body part).

Outpatient Mental Health Care

Authorization rules may apply.

0% or 40% of the cost for each Medicare-covered individual therapy visit*

0% or 40% of the cost for each Medicare-covered group therapy visit*

0% or 40% of the cost for each Medicare-covered individual therapy visit with a psychiatrist*

0% or 40% of the cost for each Medicare-covered group therapy visit with a psychiatrist*

0% or 20% of the cost for Medicare-covered partial hospitalization program services*

Podiatry Services

Authorization rules may apply.

0% or 20% of the cost for each Medicare-covered podiatry visit*

Medicare-covered podiatry visits are for medically necessary foot care.

Substance Abuse Care

Authorization rules may apply.

0% or 20% of the cost for Medicare-covered individual substance abuse outpatient treatment visits*

0% or 20% of the cost for Medicare-covered group substance abuse outpatient treatment visits*

Outpatient Rehabilitation Services

Authorization rules may apply.

Medically necessary physical therapy occupational therapy and speech and language pathology services are covered.

0% or 20% of the cost for Medicare-covered Occupational Therapy visits*

0% or 20% of the cost for Medicare-covered Physical Therapy and/or Speech and Language Pathology visits*

Prosthetic Devices

Authorization rules may apply.

0% or 20% of the cost for Medicare-covered prosthetic devices*

0% or 20% of the cost for Medicare-covered medical supplies related to prosthetics splints and other devices*

Preventive Services

$0 copay for all preventive services covered under Original Medicare at zero cost sharing. Any additional preventive services approved by Medicare mid-year will be covered by the plan or by Original Medicare.

Plan covers a physical exam annually.

Cardiac and Pulmonary Rehabilitation Services

Authorization rules may apply.

0% or 20% of the cost for Medicare-covered Cardiac Rehabilitation Services*

0% or 20% of the cost for Medicare-covered Intensive Cardiac Rehabilitation Services*

0% or 20% of the cost for Medicare-covered Pulmonary Rehabilitation Services*

Kidney Disease and Conditions

Authorization rules may apply.

0% or 20% of the cost for Medicare-covered renal dialysis*

0% or 20% of the cost for Medicare-covered kidney disease education services*

Additional Benefits

Dental Services

$0 copay for the following preventive dental benefits:

up to 1 oral exam(s) every six months

up to 1 cleaning(s) every six months

up to 1 fluoride treatment(s)

up to 1 dental x-ray(s)

0% or 20% of the cost for Medicare-covered dental benefits*

Plan offers additional supplemental comprehensive dental benefits.

$1 000 plan coverage limit for supplemental dental benefits.

Hearing Services

Authorization rules may apply.

$0 copay for: Medicare-covered diagnostic hearing exams*

up to 1 supplemental routine hearing exam(s)

$0 copay for up to 1 supplemental hearing aid(s)

$1 000 plan coverage limit for supplemental routine hearing exams and hearing aids.

Vision Services

$0 copay for: Medicare-covered diagnosis and treatment for diseases and conditions of the eye including an annual glaucoma screening for people at risk*

up to 1 supplemental routine eye exam(s)

$0 copay for

up to 1 pair(s) of eyeglasses (lenses and frames)

contact lenses

0% or 20% of the cost for one pair of Medicare-covered eyeglasses (lenses and frames) or contact lenses after cataract surgery.*

$75 plan coverage limit for supplemental eyewear

Over-the-Counter Items

Please visit our plan website to see our list of covered Over-the-Counter items. OTC items may be purchased only for the enrollee. Please contact the plan for specific instructions for using this benefit.

Mental Health Care

You get up to 190 days of inpatient psychiatric hospital care in a lifetime. Inpatient psychiatric hospital services count toward the 190-day lifetime limitation only if certain conditions are met. This limitation does not apply to inpatient psychiatric services furnished in a general hospital.

Except in an emergency your doctor must tell the plan that you are going to be admitted to the hospital.

Skilled Nursing Facility (SNF)

Authorization rules may apply.

Plan covers up to 100 days each benefit period

3-day prior hospital stay is required.

You will not be charged additional cost sharing for professional services

Home Health Care

Authorization rules may apply.

$0 copay for Medicare-covered home health visits*

Hospice

You must get care from a Medicare-certified hospice. You must consult with your plan before you select hospice.

Transportation

This plan does not cover supplemental routine transportation.

Acupuncture

This plan does not cover Acupuncture and other alternative therapies.

Wellness/Education & Other Benefits

This plan does not cover supplemental education/wellness programs.

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