EternalHealth Valor Give Back (HMO-POS) Plan H3551-003-0 Details
eternalHealth Valor Give Back is a 2024 HMO-POS Medicare Advantage plan without a prescription drug plan. This page provides a complete description of the benef
Delivery of healthcare services and costs are different than in Original Medicare, but this eternalHealth Medicare Advantage plan may offer extra benefits not included in Medicare Part A and Part B.
Plan Basics | |
---|---|
Plan ID: | H3551 003 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: | $5,500/yr |
Part B Reduction: | $85.00/mo |
Drug Plan Benefit: | Not Included |
Rx Gap Coverage: | No |
Supplemental Benefits: | Vision, Hearing |
Availability: | See List |
Insured By: | eternalHealth |
Summary of Benefits |
---|
Health Plan Cost Sharing
This eternalHealth 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 |
---|---|
Doctor Visits (In-Network) | |
Primary: | $0 |
Specialist: | $0 |
Wellness programs (e.g., fitness, nursing hotline): | None |
Preventive care: | $0 |
Foot Care (In-Network) | |
Foot exams and treatment (Medicare-covered): | 20% Coinsurance Prior Authorization Required, Referral Required |
Routine foot care: | Not Covered |
Chiropractic Care (In-Network) | |
Medicare-covered chiropractic care: | $20 Copay Referral Required |
Routine chiropractic care: | Not Covered |
Emergency Care / Urgent Care | |
Emergency room care: | 20% Coinsurance |
Urgent care: | 20% Coinsurance |
Ground ambulance: | 20% Coinsurance |
Inpatient hospital coverage: | |
Outpatient hospital coverage: | 20% Coinsurance Prior Authorization Required |
Skilled Nursing Facility: | |
Optional supplemental benefits: | |
Mental Health Services (In-Network) | |
Outpatient individual therapy visit with a psychiatrist: | 20% Coinsurance |
Outpatient group therapy visit with a psychiatrist: | 20% Coinsurance |
Inpatient hospital - psychiatric: | |
Outpatient group therapy visit: | 20% Coinsurance |
Outpatient individual therapy visit: | 20% Coinsurance |
Rehabilitation Services (In-Network) | |
Physical therapy and speech and language therapy visit: | $30 Copay Prior Authorization Required, Referral Required |
Occupational therapy visit: | $30 Copay Prior Authorization Required, Referral Required |
Medical Equipment / Supplies (In-Network) | |
Diabetes supplies: | 20% Coinsurance Prior Authorization Required |
Durable medical equipment (e.g., wheelchairs, oxygen): | 20% Coinsurance Prior Authorization Required |
Prosthetics (e.g., braces, artificial limbs): | 20% Coinsurance |
Diagnostic Procedures / Lab Services / Imaging (In-Network) | |
Diagnostic radiology services (e.g., MRI): | 20% Coinsurance Prior Authorization Required |
Lab services: | 20% Coinsurance Prior Authorization Required |
Outpatient x-rays: | 20% Coinsurance Prior Authorization Required |
Diagnostic tests and procedures: | 20% Coinsurance Prior Authorization Required |
Medicare Part B Drugs (In-Network) | |
Chemotherapy: | 20% Coinsurance |
Other Part B drugs (Medicare-covered) | 20% Coinsurance |
Feel free to download our EternalHealth Valor Give Back Summary of Benefits information.
Supplemental Benefits
The following is a summary of the supplemental benefits eternalHealth includes with this plan:
Supplemental Healthcare Service | Member Cost |
---|---|
Preventive Dental | |
Oral exam (In-Network) | Not Covered |
Fluoride treatment (In-Network) | Not Covered |
Dental x-ray(s) (In-Network) | Not Covered |
Cleaning (In-Network) | Not Covered |
Comprehensive Dental | |
Periodontics (In-Network) | Not Covered |
Non-routine services (In-Network) | Not Covered |
Diagnostic services (In-Network) | Not Covered |
Extractions (In-Network) | Not Covered |
Endodontics (In-Network) | Not Covered |
Restorative services (In-Network) | Not Covered |
Prosthodontics, other oral/maxillofacial surgery, other services (In-Network) | Not Covered |
Hearing Aids | |
Fitting/evaluation (In-Network) | Covered Limits may apply |
Hearing aids (In-Network) | Covered Limits may apply |
Hearing exam (In-Network) | Not Covered |
Vision | Maximum vision benefit: | $200.00 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
This plan does not include a Medicare Part D plan for prescriptions.
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 eternalHealth plan.
CMS Measure | Star Rating |
---|---|
2024 Overall Rating | |
Staying Healthy: Screenings, Tests, Vaccines | Plan too new to be measured |
Managing Chronic (Long Term) Conditions | Plan too new to be measured |
Member Experience with Health Plan | Plan too new to be measured |
Complaints and Changes in Plans Performance | Plan too new to be measured |
Health Plan Customer Service | Plan too new to be measured |
Drug Plan Customer Service | Plan too new to be measured |
Complaints and Changes in the Drug Plan | Plan too new to be measured |
Member Experience with the Drug Plan | Plan too new to be measured |
Drug Safety and Accuracy of Drug Pricing | Plan too new to be measured |
Plan Availability
EternalHealth Valor Give Back (H3551-003-0) 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:
- H3551-003-0: eternalHealth Valor Give Back (HMO-POS)
- H3551-002-0: eternalHealth Grand Give Back (HMO)
- H3551-001-0: eternalHealth Horizon (HMO)
Contact eternalHealth
Plan Website: | https://www.eternalhealth.com/ |
---|---|
Formulary Information: | https://www.optumrx.com/oe_rxexternal/pharmacy-locator?type=PDPClientPharmacy&var=MDETH122OE&infoid= |
Pharmacy Information: | eternalHealth Pharmacy Page |
Prospective Members: | (800)840-5431 |
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 or call 1-800-MEDICARE.
Medicare Part C Compatibility
Medicare Part C plans (HMO, PPO, PFFS) typically do not work with other types of health insurance. If you have Medicare Part A and/or Part B and decide to join a Part C plan, you will be removed from Original Medicare.
If you are enrolled in a Part C plan with prescription drug coverage, you cannot be enrolled in a stand-alone Medicare Part D plan, regardless of your chosen insurance company.
You cannot be enrolled in a Part C health plan and simultaneously hold Medicare Supplement Insurance (Medigap). Medicare Supplement plans are only compatible with Medicare Parts A and B.
Veterans enrolled in a Part C plan who also have VA Health Benefits may be able to receive care at their local VA healthcare facility. However, depending on the plan, the plan may or may not cover VA out-of-pocket healthcare or drug costs. Speak with a licensed insurance agent to discuss your options.
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
- eternalHealth, https://www.eternalhealth.com/, Last Accessed February 20, 2024
- Medicare.gov, "Understanding Medicare Advantage Plans", Last Accessed January 21, 2024
- Medicare.gov, "Compare Original Medicare & Medicare Advantage", 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 H3551-003-0 Plan Detail Page
The data on this EternalHealth Valor Give Back 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 eternalHealth 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 eternalHealth, at (800)840-5431, prior to enrollment.