Essential Care (HMO-POS)
H4869 - 009 - 0
(0 / 5)
Essential Care (HMO-POS) is a Medicare Advantage (Part C) Plan by Gold Kidney Health Plan.
This page features plan details for 2024 Essential Care (HMO-POS) H4869 – 009 – 0 available in Counties: GA, MA, PA, PL.
IMPORTANT: This page has been updated with plan and premium data for 2024.
Locations
Essential Care (HMO-POS) is offered in the following locations.
Plan Overview
Essential Care (HMO-POS) offers the following coverage and cost-sharing.
| Insurer: | Gold Kidney Health Plan |
| Health Plan Deductible: | Coming soon |
| MOOP: | $8,850 In-network |
| Drugs Covered: | No |
Ready to sign up for Essential Care (HMO-POS) ?
Medicare Part B Give Back Benefit
The Part B Premium Reduction (Medicare Part B Give Back Benefit) lowers the cost of some Medicare Advantage plans.
Essential Care (HMO-POS) qualifies for a monthly Medicare Give Back Benefit of $100.00.
| Premium Reduction: | $100.00 |
Premium Breakdown
Essential Care (HMO-POS) has a monthly premium of $0.00. This amount includes your Part C premium but does not include your Part B premium.| Part B | Part C | Part B Give Back | Total |
|---|---|---|---|
| $174.70 | $0.00 | $100.00 | $74.70 |
- Your Part B premium may differ based on factors including late enrollment, income, and disability status.
Additional Benefits
Essential Care (HMO-POS) also provides the following benefits.
| Coming soon |
| In-network | Yes |
| $8,850 In-network |
| No |
| In-network | No |
| In-network | 20% coinsurance per visit (Authorization is required.) (Referral is not required.) |
| out-of-network | 20% coinsurance per visit (Authorization is required.) (Referral is not required.) |
| In-network Primary | 20% coinsurance per visit (Not applicable.) (Not applicable.) |
| out-of-network Primary | 20% coinsurance per visit (Not applicable.) (Not applicable.) |
| In-network Specialist | 20% coinsurance per visit (Authorization is not required.) (Referral is required.) |
| out-of-network Specialist | 20% coinsurance per visit (Authorization is not required.) (Referral is required.) |
| In-network | $0 copay (Authorization is not required.) (Referral is not required.) |
| out-of-network | $0 copay (Authorization is not required.) (Referral is not required.) |
| Emergency | 20% coinsurance per visit (always covered) (Not applicable.) (Not applicable.) |
| Urgent care | 20% coinsurance per visit (always covered) (Not applicable.) (Not applicable.) |
| In-network Diagnostic tests and procedures | 20% coinsurance (Authorization is not required.) (Referral is required.) |
| out-of-network Diagnostic tests and procedures | 20% coinsurance (Authorization is not required.) (Referral is required.) |
| In-network Lab services | 20% coinsurance (Authorization is not required.) (Referral is required.) |
| out-of-network Lab services | 20% coinsurance (Authorization is not required.) (Referral is required.) |
| In-network Diagnostic radiology services (e.g., MRI) | 20% coinsurance (Authorization is required.) (Referral is required.) |
| out-of-network Diagnostic radiology services (e.g., MRI) | 20% coinsurance (Authorization is required.) (Referral is required.) |
| In-network Outpatient x-rays | 20% coinsurance (Authorization is required.) (Referral is required.) |
| out-of-network Outpatient x-rays | 20% coinsurance (Authorization is required.) (Referral is required.) |
| In-network Hearing exam | 20% coinsurance (Authorization is not required.) (Referral is not required.) |
| out-of-network Hearing exam | 20% coinsurance (Authorization is not required.) (Referral is not required.) |
| Fitting/evaluation | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
| Hearing aids – inner ear | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
| Hearing aids – outer ear | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
| Hearing aids – over the ear | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
| Oral exam | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
| Cleaning | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
| Fluoride treatment | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
| Dental x-ray(s) | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
| Non-routine services | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
| Diagnostic services | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
| Restorative services | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
| Endodontics | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
| Periodontics | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
| Extractions | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
| Prosthodontics, other oral/maxillofacial surgery, other services | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
| Routine eye exam | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
| Other | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
| Contact lenses | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
| Eyeglasses (frames and lenses) | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
| Eyeglass frames | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
| Eyeglass lenses | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
| Upgrades | Not covered (Not applicable.) (Not applicable.) |
| In-network Occupational therapy visit | 20% coinsurance (Authorization is required.) (Referral is not required.) |
| out-of-network Occupational therapy visit | 20% coinsurance (Authorization is required.) (Referral is not required.) |
| In-network Physical therapy and speech and language therapy visit | 20% coinsurance (Authorization is not required.) (Referral is required.) |
| out-of-network Physical therapy and speech and language therapy visit | 20% coinsurance (Authorization is not required.) (Referral is required.) |
| In-network | 20% coinsurance (Not applicable.) (Not applicable.) |
| out-of-network | 20% coinsurance (Not applicable.) (Not applicable.) |
| Not covered (Not applicable.) (Not applicable.) |
| In-network Foot exams and treatment | 20% coinsurance (Authorization is required.) (Referral is not required.) |
| out-of-network Foot exams and treatment | 20% coinsurance (Authorization is required.) (Referral is not required.) |
| Routine foot care | Not covered (Not applicable.) (Not applicable.) |
| In-network Durable medical equipment (e.g., wheelchairs, oxygen) | 20% coinsurance per item (Authorization is required.) (Not applicable.) |
| out-of-network Durable medical equipment (e.g., wheelchairs, oxygen) | 20% coinsurance per item (Authorization is required.) (Not applicable.) |
| In-network Prosthetics (e.g., braces, artificial limbs) | 20% coinsurance per item (Authorization is required.) (Not applicable.) |
| out-of-network Prosthetics (e.g., braces, artificial limbs) | 20% coinsurance per item (Authorization is required.) (Not applicable.) |
| In-network Diabetes supplies | 20% coinsurance per item (Authorization is not required.) (Not applicable.) |
| out-of-network Diabetes supplies | 20% coinsurance per item (Authorization is not required.) (Not applicable.) |
| Not covered (Not applicable.) (Not applicable.) |
| In-network Chemotherapy | 0-20% coinsurance (Authorization is required.) (Not applicable.) |
| out-of-network Chemotherapy | $35 copay or 0-20% coinsurance (Authorization is required.) (Not applicable.) |
| In-network Other Part B drugs | 0-20% coinsurance (Authorization is required.) (Not applicable.) |
| out-of-network Other Part B drugs | $35 copay or 0-20% coinsurance (Authorization is required.) (Not applicable.) |
| In-network Part B Insulin drugs | $35 copay (Authorization is required.) (Not applicable.) |
| out-of-network Part B Insulin drugs | $35 copay or 0-20% coinsurance (Authorization is required.) (Not applicable.) |
| In-network | Coming soon (Authorization is required.) (Referral is not required.) |
| out-of-network | Coming soon (Authorization is required.) (Referral is not required.) |
| In-network Inpatient hospital – psychiatric | Coming soon (Authorization is required.) (Referral is not required.) |
| out-of-network Inpatient hospital – psychiatric | Coming soon (Authorization is required.) (Referral is not required.) |
| In-network Outpatient group therapy visit with a psychiatrist | 20% coinsurance (Authorization is not required.) (Referral is required.) |
| out-of-network Outpatient group therapy visit with a psychiatrist | 20% coinsurance (Authorization is not required.) (Referral is required.) |
| In-network Outpatient individual therapy visit with a psychiatrist | 20% coinsurance (Authorization is not required.) (Referral is required.) |
| out-of-network Outpatient individual therapy visit with a psychiatrist | 20% coinsurance (Authorization is not required.) (Referral is required.) |
| In-network Outpatient group therapy visit | 20% coinsurance (Authorization is not required.) (Referral is required.) |
| out-of-network Outpatient group therapy visit | 20% coinsurance (Authorization is not required.) (Referral is required.) |
| In-network Outpatient individual therapy visit | 20% coinsurance (Authorization is not required.) (Referral is required.) |
| out-of-network Outpatient individual therapy visit | 20% coinsurance (Authorization is not required.) (Referral is required.) |
| In-network | Coming soon (Authorization is required.) (Referral is not required.) |
| out-of-network | Coming soon (Authorization is required.) (Referral is not required.) |
Ready to sign up for Essential Care (HMO-POS) ?
Table of Contents
SMID: MULTIPLAN_HCIHNDOGMED01_M
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