Allwell Medicare (HMO)

Allwell
Medicare Advantage Plan (with drug coverage)
Plan ID: H6446-010-0 | Carson City County, NV | 2021
Rating Not Available
Medicare Plan Overall Rating
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Allwell Medicare Drug Coverage and Costs in Carson City County, NV

Allwell Medicare Allwell Medicare Complement Allwell Medicare Boost Allwell Dual Medicare Harmony
(Dual Eligible SNP)
Drug Coverage Drug Coverage included in plan Drug Coverage included in plan Drug Coverage included in plan Drug Coverage included in plan
Plan Type HMO HMO HMO HMO
Total Monthly Premium $0.00 $16.60 $0.00 $0.00
Health Plan Premium $0.00 $0.00 $0.00 $0.00
Drug Plan Premium $0.00 $16.60 $0.00 $0.00
Standard Part B Premium $148.50 $148.50 $148.50 $148.50
Max You Pay for Health Services (in-network) $4,000.00 $3,450.00 $7,550.00 $3,450.00
Part D Deductible $0.00 $445.00 $250.00 $445.00
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Doctors, Specialists, Tests, Labs, Imaging

Allwell Medicare Allwell Medicare Complement Allwell Medicare Boost Allwell Dual Medicare Harmony
(Dual Eligible SNP)
Primary Doctor Visit $0 copay $0 copay $0 copay $0 copay
Specialist Visit $35 copay per visit $30 copay per visit $45 copay per visit $0 copay
Diagnostic Tests & Procedures $0 copay $0 copay $0 copay $0 copay
Lab Services $0 copay $0 copay $0 copay $0 copay
Diagnostic Radiology Services (like MRI) 20% coinsurance 20% coinsurance 20% coinsurance $0 copay
Outpatient X-rays $25 copay $15 copay $15 copay $0 copay

Hospitals, Skilled Nursing, Urgent Care

Allwell Medicare Allwell Medicare Complement Allwell Medicare Boost Allwell Dual Medicare Harmony
(Dual Eligible SNP)
Emergency Care $90 copay per visit (always covered) $120 copay per visit (always covered) $90 copay per visit (always covered) $0 copay
Urgent Care $30 copay per visit (always covered) $30 copay per visit (always covered) $40 copay per visit (always covered) $0 copay
Ambulance (Ground) $275 copay $275 copay $350 copay $0 copay
Inpatient Hospital Coverage $250 per day for days 1 through 6
$0 per day for days 7 through 90
$250 per day for days 1 through 6
$0 per day for days 7 through 90
$395 per day for days 1 through 5
$0 per day for days 6 through 90
$0 copay
Outpatient Hospital Coverage 20% coinsurance per visit 20% coinsurance per visit 20% coinsurance per visit $0 copay
Skilled Nursing Facility Stays $0 per day for days 1 through 20
$184 per day for days 21 through 100
$0 per day for days 1 through 20
$184 per day for days 21 through 100
$0 per day for days 1 through 20
$184 per day for days 21 through 100
$0 copay
Preventive Services $0 copay $0 copay $0 copay $0 copay

Hearing and Vision

Allwell Medicare Allwell Medicare Complement Allwell Medicare Boost Allwell Dual Medicare Harmony
(Dual Eligible SNP)
Hearing Exam $35 copay $30 copay $45 copay $0 copay
Hearing Fitting / Evaluation $0 copay $0 copay $0 copay $0 copay
Hearing Aides - All Types $0-1,350 copay $0-1,350 copay $0-1,350 copay $0 copay
Routine Eye Exam $0 copay $0 copay $0 copay $0 copay
Contact Lenses $0 copay $0 copay $0 copay $0 copay
Eyeglasses (Frames & Lenses) $0 copay $0 copay $0 copay $0 copay
Eyeglass Frames (only) Not covered Not covered Not covered Not covered
Eyeglass Lenses (only) Not covered Not covered Not covered Not covered
Upgrades (vision) Not covered Not covered Not covered Not covered

Physical, Occupational, Speech Therapy and Mental Health

Allwell Medicare Allwell Medicare Complement Allwell Medicare Boost Allwell Dual Medicare Harmony
(Dual Eligible SNP)
Occupational Therapy Visit $40 copay $35 copay $40 copay $0 copay
Physical Therapy Visit $40 copay $35 copay $40 copay $0 copay
Speech Pathology Visit $40 copay $35 copay $40 copay $0 copay
Outpatient Group Therapy with a Psychiatrist $30 copay $25 copay $40 copay $0 copay
Outpatient Individual Therapy with a Psychiatrist $30 copay $25 copay $40 copay $0 copay
Outpatient Group Therapy Visit $30 copay $25 copay $40 copay $0 copay
Outpatient Individual Therapy Visit $30 copay $25 copay $40 copay $0 copay

Dental Coverage

Allwell Medicare Allwell Medicare Complement Allwell Medicare Boost Allwell Dual Medicare Harmony
(Dual Eligible SNP)
Oral Exam $0 copay $0 copay $0 copay $0 copay
Oral Cleaning $0 copay $0 copay $0 copay $0 copay
Flouride Treatment $0 copay $0 copay $0 copay $0 copay
Dental X-rays $0 copay $0 copay $0 copay $0 copay
Non-routine Services $0 copay $0 copay $0 copay $0 copay
Diagnostic Services $0 copay $0 copay $0 copay $0 copay
Restorative Services 20% coinsurance $0 copay 50% coinsurance $0 copay
Endodontics 50% coinsurance $0 copay Not covered $0 copay
Periodontics 50% coinsurance $0 copay Not covered $0 copay
Extractions 50% coinsurance $0 copay Not covered $0 copay
Prosthodontics, Other Oral / Maxillofacial Surgery, Other Services 50% coinsurance $0 copay Not covered $0 copay

Medical Equipment, Dialysis, Diabetes

Allwell Medicare Allwell Medicare Complement Allwell Medicare Boost Allwell Dual Medicare Harmony
(Dual Eligible SNP)
Durable medical equipment (like wheelchairs & oxygen) 20% coinsurance per item 20% coinsurance per item 20% coinsurance per item $0 copay
Prosthetics (like braces, artificial limbs) 20% coinsurance per item 20% coinsurance per item 20% coinsurance per item $0 copay
Diabetes Supplies $0 copay $0 copay $0 copay $0 copay

Drug Coverage and Costs (Initial Coverage Phase)

Allwell Medicare Allwell Medicare Complement Allwell Medicare Boost Allwell Dual Medicare Harmony
(Dual Eligible SNP)
Standard Retail Pharmacy (1 month supply)
Preferred Generic $0.00 copay $0.00 copay $3.00 copay $0.00 copay
Generic $15.00 copay $20.00 copay $15.00 copay $20.00 copay
Preferred Brand $47.00 copay $47.00 copay $47.00 copay $47.00 copay
Non-Preferred Brand $100.00 copay 50% $100.00 copay 50%
Specialty Tier 33% 25% 28% 25%
Select Care Drugs $0.00 copay $0.00 copay
Standard Mail Order Pharmacy (3 month supply)
Preferred Generic $0.00 copay $0.00 copay $6.00 copay $0.00 copay
Generic $30.00 copay $60.00 copay $30.00 copay $60.00 copay
Preferred Brand $141.00 copay $141.00 copay $141.00 copay $141.00 copay
Non-Preferred Brand $300.00 copay 50% $300.00 copay 50%
Select Care Drugs $0.00 copay $0.00 copay

Important Plan Information

Plan limits may apply for the above services - There may be limits on how much the plan will provide.

Advanced Plan Approval May be Required for the above services - A process through which the physician or other health care provider is required to obtain advance approval from the plan that payment will be made for a service or item furnished to an enrollee. Unless specified otherwise with respect to a particular item or service, the enrollee is not responsible for obtaining (prior) authorization.

Physician Referral May be Required - A process through which the enrolleeā€™s primary care physician or other network physician (depending on the plan policy) permits or instructs the enrollee to obtain an item or service from another physician or other provider type.

FOR INFORMATIONAL PURPOSES ONLY

The plans listed on this page are for informational purposes only. CareListings has no plan affiliations and does not endorse any plans displayed. The information provided is based on publicly available data from the Centers for Medicare & Medicaid Services (CMS). Current data is accessible on medicare.gov. Not connected with or endorsed by the U.S. Government or the federal Medicare program. Actual plan costs and coverage can vary. Always consult a licensed insurance agent before purchasing insurance products.

Medicare Star Rating Performance

SILVERSUMMIT HEALTHPLAN, INC.
Allwell
Medicare Rating Not Available
Summary Rating of Health Plan Quality Not Available
Staying Healthy: Screenings, Tests, & Vaccines Not Available
Breast cancer screening Not Available
Colorectal cancer screening Not Available
Yearly flu vaccine Not Available
Improving or maintaining physical health Not Available
Improving or maintaining mental health Not Available
Monitoring physical activity Not Available
Checking to see if members are at a healthy weight Not Available
Managing Chronic (Long-term) Conditions Not Available
Members whose plan did an assessment of their health needs and risks Not Available
Yearly review of all medications and supplements being taken Not Available
Yearly assessment of how well plan members are able to do activities of daily living Not Available
Yearly pain screening or pain management plan Not Available
Osteoporosis management Not Available
Eye exam to check for damage from diabetes Not Available
Kidney function testing for members with diabetes Not Available
Plan members with diabetes whose blood sugar is under control Not Available
Rheumatoid arthritis management Not Available
Reducing the risk of falling Not Available
Improving bladder control Not Available
The plan makes sure member medication records are up-to-date after hospital discharge Not Available
The plan makes sure members with heart disease get the most effective drugs to treat high cholesterol Not Available
Member Experience with Health Plan Not Available
Ease of getting needed care and seeing specialists Not Available
Getting appointments and care quickly Not Available
Health plan provides information or help when members need it Not Available
Member's rating of health care quality Not Available
Member's rating of health plan Not Available
Coordination of members' health care services Not Available
Member Complaints & Changes in the Health Plan's Performance Not Available
Complaints about the health plan (more stars are better because it means fewer complaints) Not Available
Members choosing to leave the plan (more stars are better because it means fewer members choose to leave the plan) Not Available
Improvement (if any) in the health plan's performance Not Available
Health Plan Customer Service Not Available
Health plan makes timely decisions about appeals Not Available
Fairness of the health plan's appeal decisions, based on an independent reviewer Not Available
Availability of TTY services and foreign language interpretation when prospective members call the health plan 4/5 stars
Drug Plan (Part D) Star Rating Not Available
Drug Plan Customer Service Not Available
Availability of TTY services and foreign language interpretation when prospective members call the drug plan 5/5 stars
Drug plan fails to make timely decisions about appeals (more stars are better because it means fewer delays) Not Available
Fairness of drug plan's appeal decisions, based on an independent reviewer Not Available
Member Complaints & Changes in the Drug Plan's Performance Not Available
Complaints about the drug plan (more stars are better because it means fewer complaints) Not Available
Members choosing to leave the plan (more stars are better because it means fewer members choose to leave the plan) Not Available
Improvement (if any) in the drug plan's performance Not Available
Member Experience with the Drug Plan Not Available
Members' rating of drug plan Not Available
Ease of getting prescriptions filled when using the plan Not Available
Drug Safety & Accuracy of Drug Pricing Not Available
Plan provides accurate drug pricing information for Medicare's website Not Available
Taking diabetes medication as directed Not Available
Taking blood pressure medication as directed Not Available
Taking cholesterol medication as directed Not Available
Members who had a pharmacist (or other health professional) help them understand and manage their medications Not Available
The plan makes sure members with diabetes take the most effective drugs to treat high cholesterol Not Available
Last Updated: November 15, 2020

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