BMC HealthNet Plan Senior Care Options (HMO D-SNP)
H9585 - 001 - 0
(3.5 / 5)
BMC HealthNet Plan Senior Care Options (HMO D-SNP) is a Medicare Advantage (Part C) Special Needs Plan by BMC HealthNet Plan Senior Care Options.
This page features plan details for 2022 BMC HealthNet Plan Senior Care Options (HMO D-SNP) H9585 – 001 – 0 available in Barnstable, Bristol, Hampden, Plymouth, Suffolk.
IMPORTANT: This page features the 2022 version of this plan. See the 2024 version using the link below:
Locations
BMC HealthNet Plan Senior Care Options (HMO D-SNP) is offered in the following locations.
Plan Overview
BMC HealthNet Plan Senior Care Options (HMO D-SNP) offers the following coverage and cost-sharing.
| Special Needs Plan Type: | Dual-Eligible |
| Conditions Covered: |
| Insurer: | BMC HealthNet Plan Senior Care Options |
| Health Plan Deductible: | $0 |
| MOOP: | $7,550 In-network |
| Drugs Covered: | Yes |
Please Note:
- This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.
- Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.
Ready to sign up for BMC HealthNet Plan Senior Care Options (HMO D-SNP) ?
Premium Breakdown
BMC HealthNet Plan Senior Care Options (HMO D-SNP) has a monthly premium of $0. This amount includes your Part C and D premiums but does not include your Part B premium. The following is a breakdown of your monthly premium with Part B costs included.| Part B | Part C | Part D | Part B Give Back | Total |
|---|---|---|---|---|
| $170.10 | $0.00 | $0.00 | $0.00 | $170.10 |
- Your Part B premium may differ based on factors including late enrollment, income, and disability status.
- You may also qualify for “Extra Help” on drug costs. See the Part D Premium Reduction section below for more details.
Drug Info
BMC HealthNet Plan Senior Care Options (HMO D-SNP) provides the following cost-sharing on drugs. Please check the plan’s formulary for specific drugs covered.
| Drug Deductible: | $480.00 |
| Initial Coverage Limit: | $4,430.00 |
| Catastrophic Coverage Limit: | $7,050.00 |
| Drug Benefit Type: | Basic |
| Gap Coverage: | No Gap Coverage |
| Formulary Link: | Formulary Link |
Part D Premium Reduction
The Low-Income Subsidy (also known as LIS or “Extra Help”) helps people with Medicare lower the cost of prescription drugs. The table below shows how the LIS impacts the Part D premium of this plan.| Part D | LIS 25% | LIS 50% | LIS 75% | LIS Full |
|---|---|---|---|---|
| $0.00 | $27.20 | $18.20 | $9.10 | $0.00 |
Initial Coverage Phase
After you pay your $480.00 drug deductible, you will pay the following costs for drugs in each tier until your total drug costs (including what this plan has paid and what you have paid) reach $4,430.00. Once you reach that amount, you will enter the next coverage phase.
30 Day
60 Day
90 Day
30 Day
60 Day
90 Day
Gap Coverage Phase
After your total drug costs (including what this plan has paid and what you have paid) reach $4,430.00, you will pay no more than the amounts below for any drug tier until you reach $7,050.00.
30 Day
90 Day
30 Day
90 Day
| Drug Type | Cost Share |
|---|---|
| Generic drugs | 25% |
| Brand-name drugs | 25% |
Catastrophic Coverage Phase
After your yearly out-of-pocket drug costs (including drugs purchased through your retail pharmacy and through mail order) reach $7,050.00, you will pay no more than the greater of the two amounts listed below for generic and brand-name drugs.
| Drug Type | Cost Share |
|---|---|
| Generic drugs | $3.95 copay or 5% (whichever costs more) |
| Brand-name drugs | $9.85 copay or 5% (whichever costs more) |
Additional Benefits
BMC HealthNet Plan Senior Care Options (HMO D-SNP) also provides the following benefits.
Additional benefits and/or reduced cost-sharing for enrollees with certain health conditions?
| In-Network: No |
Dental (comprehensive)
| Diagnostic services: | Not covered |
| Endodontics: | Not covered |
| Extractions: | Not covered |
| Non-routine services: | Not covered |
| Periodontics: | Not covered |
| Prosthodontics, other oral/maxillofacial surgery, other services: | Not covered |
| Restorative services: | Not covered |
Dental (preventive)
| Cleaning: | Not covered |
| Dental x-ray(s): | Not covered |
| Fluoride treatment: | Not covered |
| Oral exam: | Not covered |
Diagnostic procedures/lab services/imaging
| Diagnostic radiology services (e.g., MRI): | $0 copay |
| Diagnostic tests and procedures: | $0 copay |
| Lab services: | $0 copay |
| Outpatient x-rays: | $0 copay |
Doctor visits
| Primary: | $0 copay |
| Specialist: | $0 copay |
Emergency care/Urgent care
| Emergency: | $0 copay |
| Urgent care: | $0 copay |
Foot care (podiatry services)
| Foot exams and treatment: | $0 copay |
| Routine foot care: | Not covered |
Ground ambulance
| $0 copay |
Health plan deductible
| $0.00 |
Health plan deductibles (other)
| In-Network: No |
Hearing
| Fitting/evaluation: | Not covered |
| Hearing aids – inner ear: | Not covered |
| Hearing aids – outer ear: | Not covered |
| Hearing aids – over the ear: | Not covered |
| Hearing exam: | $0 copay |
Hospital coverage (inpatient)
| $0 copay (authorization required) |
Hospital coverage (outpatient)
| $0 copay (authorization required) |
Maximum out-of-pocket enrollee responsibility (does not include prescription drugs)
| $7,550 In-network |
Medical equipment/supplies
| Diabetes supplies: | $0 copay (authorization required) |
| Durable medical equipment (e.g., wheelchairs, oxygen): | $0 copay (authorization required) |
| Prosthetics (e.g., braces, artificial limbs): | $0 copay (authorization required) |
Medicare Part B drugs
| Chemotherapy: | $0 copay (authorization required) |
| Other Part B drugs: | $0 copay (authorization required) |
Mental health services
| Inpatient hospital – psychiatric: | $0 copay (authorization required) |
| Outpatient group therapy visit with a psychiatrist: | $0 copay |
| Outpatient group therapy visit: | $0 copay |
| Outpatient individual therapy visit with a psychiatrist: | $0 copay |
| Outpatient individual therapy visit: | $0 copay |
Optional supplemental benefits
| No |
Preventive care
| $0 copay (authorization required) |
Rehabilitation services
| Occupational therapy visit: | $0 copay (authorization required) |
| Physical therapy and speech and language therapy visit: | $0 copay (authorization required) |
Skilled Nursing Facility
| $0 copay (authorization required) |
Transportation
| Not covered |
Vision
| Contact lenses: | $0 copay (limits may apply) |
| Eyeglass frames: | $0 copay (limits may apply) |
| Eyeglass lenses: | $0 copay (limits may apply) |
| Eyeglasses (frames and lenses): | $0 copay (limits may apply) |
| Other: | Not covered |
| Routine eye exam: | Not covered |
| Upgrades: | $0 copay (limits may apply) |
Wellness programs (e.g., fitness, nursing hotline)
| Covered |
Ready to sign up for BMC HealthNet Plan Senior Care Options (HMO D-SNP) ?