Medvantage Rx Plus Plan - 2013
Basic Benefit Information Disclaimer
Online Enrollment Center Disclaimer
As a Medicare Advantage Organization with a Medicare contract, FHCP can help you navigate your Medicare choices and find the plan that meets your needs. By selecting FHCP, you can take advantage of additional benefits far beyond Original Medicare. Our plans have no pre-existing condition limitations for enrollment, with the exception of End Stage Renal Disease.
In addition, we also offer an Optional Point of Service benefit that can be added on to either the Medvantage Plan or the Medvantage RX Plus plan for an additional premium.
Premium & Other Important Information
| Monthly Premium | Maximal Medical Out-Of-Pocket |
| $48.00* | $2,900 |
*You must continue to pay your Medicare Part B premium.
Physician Services
| Primary Care Physician | Specialist |
| $8 copay/visit | $35 copay visit |
Doctor Choice: You must select your Primary Care Physician from our extensive network
Specialist Referral Required: Yes, for certain services
Inpatient Care
| Inpatient Hospital Care | Skilled Nursing Facility |
| $200 per day (days 1-8) | $0 per day (days 1-7) $50 per day (days 8-20) $150 per day (days 21-100) |
PART D PRESCRIPTION BENEFIT:
Part D Annual Deductible: $0
| Tier | Initial Coverage Limit** | Coverage Gap*** | Catastrophic Coverage**** |
| Tier 1 – Preferred Generic | $0* copay | $0* copay | $2.65***** copay |
| Tier 2 – Non-Preferred Generic | $4* copay | $4* copay | $2.65***** copay |
| Tier 3 – Preferred Brand | 25%* coinsurance | 47.5%* coinsurance | $6.60***** copay |
| Tier 4 – Non-Preferred Brand | 50%* coinsurance | 47.5%* coinsurance | $6.60***** copay |
| Tier 5 – Specialty Tier | 33%* coinsurance | 79%* coinsurance Generic 47.5%* coinsurance Brand |
$2.65***** copay Generic $6.60***** copay Brand |
| Tier 6 – Injectable | 25%* coinsurance | 79%* coinsurance Generic 47.5%* coinsurance Brand |
$2.65***** copay Generic $6.60***** copay Brand |
*What you pay per prescription for a 31-day supply at a Florida Health Care Plans Preferred Pharmacy.
** INITIAL COVERAGE LEVEL – You pay the following until total yearly drug costs reach $2,970
*** COVERAGE GAP - After your total yearly drug costs reach $2,970, you receive limited coverage by the plan on certain drugs. You will also receive a discount on brand name drugs and generally pay no more than 47.5% for the plan's costs for brand drugs and 79% of the plans costs for generic drugs, until your yearly out-of pocket drug costs reach $4,750
**** CATASTROPHIC COVERAGE - What you pay after your yearly out-of-pocket drugs cost $4,750
***** or 5% whichever is less
Outpatient Care
| Outpatient Mental Health Care: | $35 copay for each Medicare-covered individual or group therapy visit |
| Outpatient Substance Abuse Care: | $35 copay for each Medicare-covered individual or group therapy visit |
| Outpatient Services/Surgery: | $100 copay for each Medicare-covered ambulatory surgical center visit. $0 to $200 copay for each Medicare- covered outpatient hospital facility visit |
| Emergency Care: | $65 copay for Medicare-covered emergency room visits Worldwide coverage |
| Urgently Needed Care: | $35 copay for Medicare-covered urgently needed care visits |
| Ambulance Services: | $175 copay for Medicare-covered ambulance benefits |
| Outpatient Rehabilitation Services: | $20 copay for Medicare-covered Occupational Therapy visits, Physical and/or Speech and Language Therapy visits. |
Outpatient Medical Services & Supplies
| Durable Medicare Equipment: | 20% of the cost for Medicare-covered items |
| Prosthetic Devices: | 20% of the cost for Medicare-covered items |
| Diagnostic Tests, X-rays, Lab Services, and Radiology Services: |
$0 copay for Medicare-covered lab services $0 to $175 copay for Medicare-covered diagnostic procedures and tests $10 to $50 copay for Medicare-covered X-rays $10 to $200 copay for Medicare-covered diagnostic radiology services $10 to $50 copay for Medicare-covered therapeutic radiology services |
| Cardiac and Pulmonary Rehabilitation Services: |
$20 copay for Medicare-covered Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, and Pulmonary Rehabilitation Services |
| Hearing Services: | $0 copay for Medicare-covered diagnostic hearing exams. $0 copay for:
|
| Vision Services: | $15 copay for a Medicare-covered eye exam by an Optometrist $35 copay for a Medicare-covered eye exam by an Ophthalmologist, referral required Covered up to a $90 credit toward the purchase of eyeglasses from a participating Optometrist every two years |
To View Full Medvantage Plan Details:
Full plan details are available in PDF format.To access the document(s) Adobe Reader® must be installed on your computer. If you do not have Adobe Reader, you can download it for free by clicking here.
