EmblemHealth Essential for Richmond, NY
Medicare Advantage Plan Summary & Benefits
EmblemHealth Essential (H3330-032) is a Health Maintenance Organization (HMO) Medicare Advantage plan for beneficiaries who live in Richmond County, New York. It features the same coverage benefits as Original Medicare, for hospital and doctor coverage, and may also include prescription drug coverage and other extras. The number one benefit of an HMO Advantage plan is that your out-of-pocket costs are usually lower and more predictable than they are with Medicare Part A and B deductibles, co-payments and co-insurances.
With an HMO, you must use the network plan providers to avoid incurring additional costs. You are responsible for all out of network care costs. To see a specialist, you typically need a referral from your primary care physician.
The health care benefit information provided here is an overview only and not a comprehensive description of available benefits. Additional information about the plan benefits is available from your agent.
The monthly premium for this healthcare plan is $0.00 plus your monthly Medicare Part B premium. Most Medicare Beneficiaries pay the standard monthly Part B premium in addition to their MA or MAPD plan premium. However, some beneficiaries are required to pay slightly higher Part B and Part D premiums because of their income (over $85,000 per year for singles or $170,000 for married couples), or due to late enrollment penalties.
Summary of Benefits
NOTE: As of this publication date the Summary of Benefits information for this 2014 plan was not available from CMS. Please Contact an Agent and ask for the Summary of Benefits document.
Part D Plan Information
The Part D deductible for this plan is $0.00. That means you have first dollar coverage.
Maximum Out of Pocket (MOOP) Benefit
The new Affordable Care Act (aka, ObamaCare) law placed a mandatory maximum limit of $6,700 on all out of pocket medical costs for 2014 Medicare Advantage plans, which is referred to as the Maximum Out of Pocket or MOOP. The MOOP does not include prescriptions and monthly premiums. The Mandatory MOOP is $6,700 but the Affordable Care Act allows for a “Voluntary MOOP” as low as $3,400. The MOOP with this health plan is $3,400 .
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About The Insurer EmblemHealth Medicare HMO
The summary (overall) rating for this EmblemHealth Medicare HMO plan is 4.0 out of 5 based on reviews from 11903 user ratings from the previous year. For more information about the review process, visit http://cms.gov.