2014 Meridian Advantage Plan of Iowa (HMO SNP) H5786-001

Meridian Advantage Plan of Iowa (HMO SNP) By Meridian Health Plan



Meridian Advantage Plan of Iowa (HMO SNP) is a 2014 Medicare Advantage Special Needs Plan plan by Meridian Health Plan. This plan from Meridian Health Plan works with Medicare to give you significant coverage beyond original Medicare. If you decide to sign up you still retain Original Medicare. But you will get additional Part A (Hospital Insurance) and Part B (Medical Insurance) coverage from Meridian Health Plan and not Original Medicare. All Medicare SNPs also provide Medicare additional Part-D drug coverage. Meridian Advantage Plan of Iowa (HMO SNP) H5786-001 is a Dual Eligible Special Needs Plan (D-SNP). A Dual Eligible SNP is for beneficiaries who are eligible for both Medicare and Medicaid. If you have Medicare and get help from Medicaid you can join any Medicare SNP you qualify for or switch plans at any time.



2014 Medicare Special Needs Plan Details

Plan Name:
Meridian Advantage Plan of Iowa (HMO SNP)
Plan ID:
H5786-001
Special Needs Type: Dual-Eligible
Provider: Meridian Health Plan
Plan Year:2014
Plan Type: Local HMO
Monthly Premium C+D: $32.20


Coverage Area for Meridian Advantage Plan of Iowa (HMO SNP)

State: Iowa
County:Polk,
Scott,


The Meridian Advantage Plan of Iowa (HMO SNP) H5786-001 is available to residents in Iowa, and all Medicare SNPs must provide Medicare additional prescription drug (Part-D) coverage. Meridian Advantage Plan of Iowa (HMO SNP) is a Local HMO. With a health maintenance organization (HMO) you will be required to receive most of your health care from an in-network provider. Health maintenance organizations require that you select a primary care physician (PCP). Your PCP will serve as your personal doctor to provide all of your basic healthcare services. If you need special care for a physician specialist, your primary care physician will make the arrangements and tell you where you can go in the network. You will need your PCPs okay, called a referral. Without getting a referral or services received from out-of-network providers are not typically covered by the plan.



Total Ratings for Meridian Advantage Plan of Iowa (HMO SNP) H5786

2014 Overall Rating
Part C Summary Rating
Total Experience Rating
Complaints, Improvements
Total Customer Service Rating
Total Preventative Rating
Chronic And Long Term Care


Member Experience Rating for Meridian Advantage Plan of Iowa (HMO SNP)

Total Experience Rating
Getting Needed Care
Timely Care and Appointments
Customer Service
Health Care Quality
Rating of Health Plan
Care Coordination


Member Complaints, Problems Getting Service and Improvements in Health Plans

Total Rating
Members Leaving the Plan
Complaints about Health Plan
Access to Service
Performance Problems
Health Plan Quality Improvement


Customer Service Rating for Meridian Advantage Plan of Iowa (HMO SNP)

Total Customer Service Rating
Timely Decisions About Appeals
Reviewing Appeals Decisions
Call Center


Staying Healthy, Screening, Testing, & Vaccines

Total Preventative Rating
Breast Cancer Screening
Colorectal Cancel Screening
Cardiovascular Screening
Diabetes Care
Glaucoma Testing
Annual Flu Vaccine
Improving Physical
Improving Mental Health
Monitoring Physical Activity
Adult BMI Assessment


Ratings For Managing Chronic And Long Term Care

Total Rating
Medication Review
Functional Status Assessment
Pain Screening
Osteoporosis Management
Diabetes Care - Eye Exam
Diabetes Care - Kidney Disease
Diabetes Care - Blood Sugar
Diabetes Care - Cholesterol
Controlling Blood Pressure
Rheumatoid Arthritis
Improving Bladder Control
Reducing Risk of Falling
Plan - Cause Readmissions


Part-C Premium

Meridian Health Plan plan charges a $0.00 Part-C premium. The Part C premium covers Medicare medical, hospital benefits and supplemental benefits if offered. You generally are also responsible for paying the Part B premium.



Part-D Deductible and Premium

The Meridian Advantage Plan of Iowa (HMO SNP) plan has a monthly drug premium of $32.20 and a $310.00 drug deductible. This Meridian Health Plan plan offers a $32.20 Part D Basic Premium that is below the regional benchmark. This covers the basic prescription benefit only and does not cover enhanced drug benefits such as medical benefits or hospital benefits. The Part D Supplemental Premium is $0.00 this Premium covers any enhanced plan benefits offered by Meridian Health Plan above and beyond the standard PDP benefits. This can include additional coverage in the gap, lower co-payments and coverage of non-Part D drugs. The Part D Total Premium is $32.20. The Part D Total Premium is the addition of the supplemental and basic premiums for some plans this amount can be lower due to negative basic or supplemental premiums.



Premium Assistance

Depending on your income level you may be eligible for full 75%, 50%, 25% premium assistance. The Meridian Advantage Plan of Iowa (HMO SNP) medicare insurance plan offers a $0.00 premium obligation if you receive a full low-income subsidy (LIS) assistance. And the payment is $8.00 for 75% low income subsidy $16.10 for 50% and $24.10 for 25%.



Part C Premium: $0.00
Part D (Drug) Premium: $32.20
Part D Supplemental Premium $0.00
Total Part D Premium: $32.20
Drug Deductible: $310.00
Tiers with No Deductible: 0
Benchmark: below the regional benchmark
Type of Medicare Health Plan: Defined Standard Benefit
Drug Benefit Type: Basic
Full LIS Premium: $0.00
75% LIS Premium: $8.00
50% LIS Premium: $16.10
25% LIS Premium: $24.10
Inital Coverage Limit:$2850
Gap Coverage: No Gap Coverage


Gap Coverage

In 2014 once you and your plan provider have spent $2,850 on covered drugs. (combined amount plus your deductible) You will be in the coverage gap. (AKA "donut hole") You will be require to pay 47.5% of the plan's cost for covered brand-name prescription drugs and 72% of the cost for generic drugs unless your plan offers additional coverage. This Meridian Health Plan plan covers No Gap Coverage through the gap. No Gap Coverage means 0% of formulary drugs are covered through the gap or 15 or less brand name products are covered through the gap.



Source: CMS.

Plans as of September 3, 2013.

Star Rating as of September 27, 2013.

For More Information on Ratings Please See the CMS Tech Notes Here.

Plans are subject to change as contracts are finalized.

Includes 2014 approved contracts/plans. Employer sponsored 800 series plans and plans under sanction are excluded.

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