CommuniCare Advantage Cal MediConnect Plan (Medicare-Medicaid Plan) is a Medicare Advantage (Part C) Plan by .
This page features plan details for 2022 CommuniCare Advantage Cal MediConnect Plan (Medicare-Medicaid Plan) H5172 – 002 – 0 available in San Diego, California.
CommuniCare Advantage Cal MediConnect Plan (Medicare-Medicaid Plan) is offered in the following locations.
CommuniCare Advantage Cal MediConnect Plan (Medicare-Medicaid Plan) offers the following coverage and cost-sharing.
| Insurer: | |
| Health Plan Deductible: | $0 |
| MOOP: | Not Applicable |
| Drugs Covered: | Yes |
Ready to sign up for CommuniCare Advantage Cal MediConnect Plan (Medicare-Medicaid Plan) ?
| Part B | Part C | Part D | Part B Give Back | Total |
|---|---|---|---|---|
| $170.10 | $0.00 | $0.00 | $0.00 | $0.00 |
CommuniCare Advantage Cal MediConnect Plan (Medicare-Medicaid Plan) provides the following cost-sharing on drugs. Please check the plan’s formulary for specific drugs covered.
| Drug Deductible: | $0.00 |
| Initial Coverage Limit: | $ |
| Catastrophic Coverage Limit: | $7,050.00 |
| Drug Benefit Type: | |
| Gap Coverage: | |
| Formulary Link: | Formulary Link |
| Part D | LIS 25% | LIS 50% | LIS 75% | LIS Full |
|---|---|---|---|---|
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
After you pay your $0.00 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 $. Once you reach that amount, you will enter the next coverage phase.
After your total drug costs (including what this plan has paid and what you have paid) reach $, you will pay no more than the amounts below for any drug tier until you reach $7,050.00.
| Tier | Cost |
|---|---|
| All other tiers (Generic) | 25% |
| All other tiers (Brand-name) | 25% |
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.
| Tier | Cost |
|---|---|
| Generic | $4.15 copay or 5% (whichever costs more) |
| Brand-name | $10.35 copay or 5% (whichever costs more) |
CommuniCare Advantage Cal MediConnect Plan (Medicare-Medicaid Plan) also provides the following benefits.
| In-Network: No |
| 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 |
| Cleaning: | Not covered |
| Dental x-ray(s): | Not covered |
| Fluoride treatment: | Not covered |
| Oral exam: | Not covered |
| Diagnostic radiology services (e.g., MRI): | $0 copay (authorization required) (referral required) |
| Diagnostic tests and procedures: | $0 copay (authorization required) (referral required) |
| Lab services: | $0 copay (authorization required) (referral required) |
| Outpatient x-rays: | $0 copay (authorization required) (referral required) |
| Primary: | $0 copay |
| Specialist: | $0 copay (authorization required) |
| Emergency: | $0 copay |
| Urgent care: | $0 copay |
| Foot exams and treatment: | $0 copay (authorization required) (referral required) |
| Routine foot care: | Not covered |
| $0 copay |
| $0.00 |
| In-Network: No |
| Fitting/evaluation: | Not covered |
| Hearing aids: | $0 copay (limits may apply) (authorization required) (referral required) |
| Hearing exam: | $0 copay (authorization required) (referral required) |
| $0 copay (authorization required) |
| $0 copay (authorization required) (referral required) |
| Not Applicable |
| Diabetes supplies: | $0 copay |
| Durable medical equipment (e.g., wheelchairs, oxygen): | $0 copay (authorization required) |
| Prosthetics (e.g., braces, artificial limbs): | $0 copay (authorization required) |
| Chemotherapy: | $0 copay (authorization required) |
| Other Part B drugs: | $0 copay (authorization required) |
| Inpatient hospital – psychiatric: | $0 copay (authorization required) |
| Outpatient group therapy visit with a psychiatrist: | $0 copay (authorization required) |
| Outpatient group therapy visit: | $0 copay |
| Outpatient individual therapy visit with a psychiatrist: | $0 copay (authorization required) |
| Outpatient individual therapy visit: | $0 copay |
| No |
| $0 copay (authorization required) (referral required) |
| Occupational therapy visit: | $0 copay (authorization required) |
| Physical therapy and speech and language therapy visit: | $0 copay (authorization required) (referral required) |
| $0 copay (authorization required) |
| $0 copay (referral required) |
| Contact lenses: | $0 copay (limits may apply) |
| Eyeglass frames: | Not covered |
| Eyeglass lenses: | Not covered |
| Eyeglasses (frames and lenses): | $0 copay (limits may apply) |
| Other: | Not covered |
| Routine eye exam: | $0 copay (limits may apply) |
| Upgrades: | Not covered |
| Covered (authorization required) (referral required) |
Ready to sign up for CommuniCare Advantage Cal MediConnect Plan (Medicare-Medicaid Plan) ?
Get help enrolling in a Medicare Advantage or Medicare Prescription Drug Plan by calling a licensed insurance agent today.
Medicare Advantage and Part D plans and benefits offered by the following carriers: Aetna Medicare, Anthem Blue Cross Blue Shield, Anthem Blue Cross, Aspire Health Plan, Cigna Healthcare, Dean Health Plan, Devoted Health, Florida Blue Medicare, GlobalHealth, Health Care Service Corporation, Healthy Blue, Humana, Molina Healthcare, Mutual of Omaha, Premera Blue Cross, Medica Central Health Plan, SCAN Health Plan, Baylor Scott & White Health Plan, Simply, UnitedHealthcare(R), Wellcare, WellPoint.
SMID: MULTIPLAN_HCIHNDOGMED01_M
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