AvMed Medicare One (HMO) 2024 Benefit Details for Plan H1016-031-0 by AvMed Medicare
AvMed Medicare One is a 2024 HMO Medicare Advantage plan {with_without_pdp} Part D.
This AvMed Medicare option offers the same basic benefits as Original Medicare, but out-of-pocket costs are different. It may also include additional, valuable benefits not covered by Part A or Part B.
Plan Basics | |
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Plan ID: | H1016 031 0 |
Plan Type: | Local HMO |
Plan Year: | 2024 |
Premium: | $0.00/mo Plus your Medicare Part B premium. |
Health Plan Deductible: | $0.00 |
Out-of-Pocket Maximum: | $1,000/yr |
Part B Reduction: | $0.00/mo |
Drug Plan Benefit: | Enhanced, $0.00 deductible |
Rx Gap Coverage: | Yes |
Supplemental Benefits: | Dental, Vision, Hearing |
Availability: | See List |
Insured By: | AvMed Medicare |
Summary of Benefits |
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Health Plan Cost Sharing
This AvMed Medicare Medicare Advantage plan has cost-sharing. These are costs you must pay out-of-pocket when you use approved health services.
NOTE: Most preventive services are covered 100% by the plan as a Part B benefit.
The following table summarizes the most common out-of-pocket costs you will incur if you join this plan unless you go out-of-network:
Healthcare Service | Member Cost |
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Doctor Visits (In-Network) | |
Primary: | $0 |
Specialist: | $0 Copay |
Wellness programs (e.g., fitness, nursing hotline): | None |
Preventive care: | $0 Copay |
Foot Care (In-Network) | |
Foot exams and treatment (Medicare-covered): | $5 Copay |
Routine foot care: | $5 Copay |
Chiropractic Care (In-Network) | |
Medicare-covered chiropractic care: | $5 Copay |
Routine chiropractic care: | Not Covered |
Emergency Care / Urgent Care | |
Emergency room care: | $75 Copay |
Urgent care: | $10 Copay |
Ground ambulance: | $145 Copay |
Inpatient hospital coverage: | |
Outpatient hospital coverage: | $50 Copay Authorization Required |
Skilled Nursing Facility: | $0.00 per day for days 1 through 20 $160.00 per day for days 21 through 62 $0.00 per day for days 63 and beyond |
Optional supplemental benefits: | |
Mental Health Services (In-Network) | |
Outpatient individual therapy visit with a psychiatrist: | $15 Copay |
Outpatient group therapy visit with a psychiatrist: | $15 Copay |
Inpatient hospital - psychiatric: | $0.00 per day for days 1 through 90 |
Outpatient group therapy visit: | $15 Copay |
Outpatient individual therapy visit: | $0 |
Rehabilitation Services (In-Network) | |
Physical therapy and speech and language therapy visit: | $0 Copay Referral Required |
Occupational therapy visit: | $0 Copay Referral Required |
Medical Equipment / Supplies (In-Network) | |
Diabetes supplies: | 0% Coinsurance |
Durable medical equipment (e.g., wheelchairs, oxygen): | 10% Coinsurance Authorization Required |
Prosthetics (e.g., braces, artificial limbs): | $0 |
Diagnostic Procedures / Lab Services / Imaging (In-Network) | |
Diagnostic radiology services (e.g., MRI): | $0 Copay |
Lab services: | $0 Copay |
Outpatient x-rays: | $0 Copay |
Diagnostic tests and procedures: | $15 Copay |
Medicare Part B Drugs (In-Network) | |
Chemotherapy: | 20% Coinsurance |
Other Part B drugs (Medicare-covered) | 20% Coinsurance |
Feel free to download our AvMed Medicare One Summary of Benefits information.
Supplemental Benefits
The following is a summary of the supplemental benefits AvMed Medicare includes with this plan:
Supplemental Healthcare Service | Member Cost |
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Preventive Dental | Maximum dental benefit: | Non Specified |
Oral exam (In-Network) | Covered |
Fluoride treatment (In-Network) | Not Covered |
Dental x-ray(s) (In-Network) | Covered |
Cleaning (In-Network) | Covered |
Comprehensive Dental | |
Periodontics (In-Network) | Covered |
Non-routine services (In-Network) | Covered |
Diagnostic services (In-Network) | Covered |
Extractions (In-Network) | Covered |
Endodontics (In-Network) | Covered |
Restorative services (In-Network) | Covered |
Prosthodontics, other oral/maxillofacial surgery, other services (In-Network) | Covered |
Hearing Aids | |
Fitting/evaluation (In-Network) | Covered Limits may apply |
Hearing aids (In-Network) | Covered Limits may apply |
Hearing exam (In-Network) | Covered Limits may apply |
Vision | Maximum vision benefit: | $450.00 Every year |
Eyeglasses (frames and lenses) (In-Network) | Covered Limits may apply |
Routine eye exam (In-Network) | Covered Limits may apply |
Contact lenses (In-Network) | Covered Limits may apply |
Additional Benefits
None specified.
Prescription Drug Plan Costs & Benefits
AvMed Medicare One includes an enhanced benefit Medicare Part D plan (PDP). Enhanced plans have a higher actuarial value than basic plans. Actuarial value simply refers to the percentage of cost that's covered by the plan.
Prescription Drug Plan Premium
Although the prescription drug plan (Part D) premium is bundled with the total plan cost, some plans have supplemental costs and/or offer low-income subsidy (LIS) assistance. LIS, also known as Extra Help, is a Social Security program that helps people with limited income and resources lower or cut Part D costs.
The following table outlines the prescription drug plan premium details of this plan.
Basic Part D Premium: | $0.00 |
Supplemental Part D Premium: | $0.00 |
Total Part D Premium: | $0.00 |
Part D Premium with Full LIS Assistance: | $0.00 |
If you would like more information about the Extra Help program, you can refer to the Social Security Extra Help page.
Prescription Drug Plan Deductible
The Medicare Part D annual deductible with this plan is $0.00. This is the amount you must pay at the pharmacy before AvMed Medicare begins paying its share.
Prescription Drug Plan Out-of-Pocket Costs
In addition to the plan's monthly premium and deductible, AvMed Medicare One has out-of-pocket costs that you must pay when you pick up your prescriptions.
Drug Tier | Preferred | Standard |
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1 (Preferred Generic) | $0.00 copay | $0.00 copay |
2 (Generic) | $0.00 copay | $10.00 copay |
3 (Preferred Brand) | $0.00 copay | $25.00 copay |
4 (Non-Preferred Drug) | $35.00 copay | $85.00 copay |
5 (Specialty Tier) | 33% | 33% |
CMS Rating Marks for 2024
Each year Medicare rates health plans (Part C) and drug plans (Part D) in several major categories based on a 5-star rating system. These ratings are designed to help you understand the quality of care and service you can expect if you join this AvMed Medicare plan.
CMS Measure | Star Rating |
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2024 Overall Rating | |
Staying Healthy: Screenings, Tests, Vaccines | |
Managing Chronic (Long Term) Conditions | |
Member Experience with Health Plan | |
Complaints and Changes in Plans Performance | |
Health Plan Customer Service | |
Drug Plan Customer Service | |
Complaints and Changes in the Drug Plan | |
Member Experience with the Drug Plan | |
Drug Safety and Accuracy of Drug Pricing |
In terms of quality, this Medicare Advantage HMO plan is just average. AvMed Medicare One does an excellent job keeping its members healthy through its preventive care program with proactive screenings, tests, and vaccines. This plan is good at managing its member's chronic (long-term) health conditions.
The member experience with this AvMed Medicare plan is average. Complaints and changes in performance with this plan are average. The plan shines at customer service with an overall excellent mark on this important metric.
If you're looking for more value, this plan offers dental, vision, and hearing benefits (limitations may apply) that are not included with Original Medicare.
With no additional monthly premium, this plan can save you money if you're healthy. AvMed Medicare One has an exceptionally low maximum out-of-pocket (MOOP) limit. It's just $1,000 per year. With a MOOP this low, your out-of-pocket costs for a 5-day stay in the hospital are much lower than Original Medicare. With no annual deductible, members of this health plan have first dollar coverage, which is comforting on a fixed budget.
Plan Availability
AvMed Medicare One (H1016-031-0) is available in the following locations (click to open):
Additional Medicare Advantage Plan Options
The Medicare Advantage program offers a myriad of options, including these plans:
- H1016-029-0: AvMed Medicare One (HMO)
- H1016-032-0: AvMed Medicare One (HMO)
- H1016-031-0: AvMed Medicare One (HMO)
- H1016-025-0: AvMed Medicare Access (HMO-POS)
- H1016-024-0: AvMed Medicare Circle (HMO)
Contact AvMed Medicare
Plan Website: | http://www.avmed.org |
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Formulary Information: | http://www.avmed.org |
Pharmacy Information: | AvMed Medicare Pharmacy Page |
Prospective Members: | (800)535-9355 |
TTY Users: | 711 |
If you qualify for Medicare benefits but have not yet enrolled or verified your enrollment status, you can do so on the Social Security Administration website. You can learn more about the Medicare Advantage program on www.medicare.gov.
Plans Offered
Medicare Advantage and Part D plans and benefits offered by the following carriers: Aetna Medicare, Anthem Blue Cross Blue Shield, Aspire Health Plan, Dean Health Plan, Devoted Health, GlobalHealth, Health Care Service Corporation, Cigna Healthcare, Humana, Molina Healthcare, Mutual of Omaha, Premera Blue Cross, Medica Central Health Plan, SCAN Health Plan, Scott and White Health Plan now part of Baylor Scott & White Health, UnitedHealthcare(R), and Wellcare.
Citations & References
- AvMed Medicare, http://www.avmed.org, Last Accessed February 20, 2024
- Medicare.gov, "Understanding Medicare Advantage Plans", Last Accessed January 21, 2024
- Medicare.gov, "Your Medicare coverage choices", Last Accessed February 19, 2024
- Medicare.gov, "Medicare & You in Different Formats", Last Accessed February 19, 2024
- Medicare.gov, "Your Medicare Coverage", Last Accessed April 11, 2023
- CMS.gov, Landscape Source Files, Last Accessed February 21, 2024
- CMS.gov, Medicare Part C & D Performance, Last Accessed February 21, 2024
- CMS.gov, Plan Benefits Package, Last Accessed February 21, 2024
About This H1016-031-0 Plan Detail Page
The data on this AvMed Medicare One plan detail page is derived from the 2024 Landscape Source Files, Plan Benefit Package, and Medicare Part C and Part D Performance Data published by CMS.
The author interprets these files, and their associated data dictionary, with great care, making every attempt to communicate the data submitted by AvMed Medicare to CMS as clearly and accurately as possible. Given the complexity of the data, the author recommends that all potential enrollees request an official Summary of Benefits from AvMed Medicare, at (800)535-9355, prior to enrollment.