Meridian Advantage Plan of Iowa (HMO SNP) Benefits

Meridian Health Plan | HMO
Plan website: www.medicaremeridian.com
Plan Phone Number: (855) 647-0075
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 (855) 647-0075 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.

$0 annual service category deductible*

$0 copay*

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

$0 copay for each Medicare-covered primary care doctor visit.*

$0 copay 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

$0 copay for Medicare-covered:

lab services*

diagnostic procedures and tests*

X-rays*

diagnostic radiology services (not including X-rays)*

therapeutic radiology services*

Emergency Care

$0 annual service category deductible*

$0 copay 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

$0 annual service category deductible*

Authorization rules may apply.

$0 copay for Medicare-covered durable medical equipment*

Diabetes Programs and Supplies

$0 copay for Medicare-covered Diabetes self-management training*

$0 copay for Medicare-covered:

Diabetes monitoring supplies*

Therapeutic shoes or inserts*

Ambulance Services

Authorization rules may apply.

$0 copay for Medicare-covered ambulance benefits.*

Urgently Needed Care

$0 copay for Medicare-covered urgently-needed-care visits*

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

Outpatient Services

Authorization rules may apply.

$0 copay for each Medicare-covered ambulatory surgical center visit*

$0 copay for each Medicare-covered outpatient hospital facility visit*

Chiropractic Services

Authorization rules may apply.

$0 copay for Medicare-covered chiropractic visits*

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 copay for:

each Medicare-covered individual therapy visit*

each Medicare-covered group therapy visit*

$0 copay for:

each Medicare-covered individual therapy visit with a psychiatrist*

each Medicare-covered group therapy visit with a psychiatrist*

$0 copay for Medicare-covered partial hospitalization program services*

Podiatry Services

Authorization rules may apply.

$0 copay for Medicare-covered podiatry visits*

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

Substance Abuse Care

Authorization rules may apply.

$0 copay for:

each Medicare-covered individual substance abuse outpatient treatment visit*

each Medicare-covered group substance abuse outpatient treatment visit*

Outpatient Rehabilitation Services

Authorization rules may apply.

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

$0 copay for Medicare-covered Occupational Therapy visits*

$0 copay for Medicare-covered Physical Therapy and/or Speech and Language Pathology visits*

Prosthetic Devices

Authorization rules may apply.

$0 copay for Medicare-covered:

prosthetic devices*

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 copay for:

Medicare-covered Cardiac Rehabilitation Services*

Medicare-covered Intensive Cardiac Rehabilitation Services*

Medicare-covered Pulmonary Rehabilitation Services*

Kidney Disease and Conditions

$0 copay for Medicare-covered renal dialysis*

$0 copay for Medicare-covered kidney disease education services*

Additional Benefits

Dental Services

$0 annual service category deductible for Medicare-covered dental benefits*

$0 copay for Medicare-covered dental benefits*

In general preventive dental benefits (such as cleaning) not covered.

Hearing Services

Authorization rules may apply.

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

supplemental routine hearing exams

fitting-evaluations for a supplemental hearing aid

$0 copay for supplemental hearing aids.

$600 plan coverage limit for supplemental routine hearing exams and hearing aids every year.

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*

supplemental routine eye exams

$0 copay for one pair of Medicare-covered eyeglasses (lenses and frames) or contact lenses after cataract surgery *

eyeglasses (lenses and frames)

contact lenses

eyeglass lenses

eyeglass frames

$220 plan coverage limit for supplemental eyewear every year

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.

$0 annual service category deductible*

$0 copay*

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

No prior hospital stay is required.

$0 annual service category deductible*

$0 copay for SNF services*

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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