Amerivantage Comfort (I-SNP HMO) 2023 Maricopa County, Arizona Medicare Advantage Special Needs Plan
Amerivantage Comfort is a I-SNP Medicare Advantage Special Needs Plan (HMO), from Amerigroup, that's available in Maricopa County, Arizona. It offers all of the same basic benefits as Original MedicareOriginal Medicare is private fee-for-service health insurance for people on Medicare. It has two parts. Part A is hospital coverage. Part B is medical coverage., plus some additional benefits that Medicare Part AMedicare Part A is hospital coverage for Medicare beneficiaries. It covers inpatient care in hospitals and skilled nursing facilities. It also covers limited home healthcare services and hospice care. and Part B do not cover, but out-of-pocket costsOut-of-Pocket Costs for Medicare are the remaining costs that are not covered by the beneficiary's health insurance plan. These costs can come from the beneficiary's monthly premiums, deductibles, coinsurance, and copayments. are different.
CMS rated this plan 3.5 (Above Average) out of 5 stars.
Key Takeaways
- Amerivantage Comfort is a private HMO health plan for people who are institutionalized.
- This plan accomodates individuals in a long-term carea variety of services that help people with their medical and non-medical needs over a period of time. Long-term care can be provided at home, in the community, or in various types of facilities, including... facility. It is also available to people who need the level of care given in a long-term care facility who can remain at home or live in an assisted living facility.
- If you qualify and enroll, this HMO plan replaces your Original Medicare coverage and offers the same benefits as Medicare Part A and Part B.
- To qualify, you must have Medicare Part A and Part B, you must live in the plan's service area, and you must live in an institution (like a nursing home) or require nursing care at home.
- This Amerigroup plan includes Medicare Part DMedicare Part D plans are an option Medicare beneficiaries can use to get prescription drug coverage. Part D plans provide cost-sharing on covered medications in four different phases: deductible, initial coverage, coverage gap, and catastrophic. Each... prescription drug coverage and other benefits not covered by Original Medicare.
- The Part D plan does not have an annual deductible. Cost-sharing begins with your first prescription.
- If you qualify for the Social Security "Extra Help" program you can get financial assistance to help pay your Medicare Part D monthly premium, annual deductible, and prescription copaymentsA copayment, also known as a copay, is a set dollar amount you are required to pay for a medical service..
- If you don't qualify to join an SNP plan like this one, you can compare Maricopa County, Arizona Medicare Advantage plans.
| Plan Basics | |
|---|---|
| Plan ID: | H2593-019-0 |
| Plan Type: | I-SNP |
| Network Type: | HMO |
| Plan Year: | 2023 |
| Premium: | $0.00/mo Plus your Part B premium. |
| Health Plan Deductible: | $0.00 |
| Out-of-Pocket Maximum: | $3,000 In-networkDoctors, hospitals, pharmacies, and other healthcare providers that agree to health plan members' services and supplies at a set price are in-network providers. With some health plans, your care is only covered if you get... |
| Drug Plan Benefit: | Enhanced $0.00 deductible |
| Rx Gap Coverage: | Yes |
| Supplemental Benefits: | Dental, Vision, Hearing |
| Availability: | Maricopa County, AZ |
| Insured By: | Amerigroup |
Health Plan Costs & Benefits
Amerivantage Comfort is a Health Maintenance Organization (HMO) plan. HMO plan members usually receive health care services through the plan’s local network of providers. Referrals are almost always required to see a specialist and other providers. However, Amerivantage Comfort does allow out-of-network care for emergencies and out-of-area dialysis.
PremiumsA premium is an amount that an insurance policyholder must pay for coverage. Premiums are typically paid on a monthly basis. In the federal Medicare program, there are four different types of premiums. , deductiblesA deductible is an amount a beneficiary must pay for their health care expenses before the health insurance policy begins to pay its share., and copays vary widely from plan to plan. It is very important to compare costs and apply them to your personal financial and healthcare needs.
Monthly Premium
Amerivantage Comfort's total monthly premium in Maricopa County is $0.00. This includes your prescription coverage, as well. Plus, you must continue to pay your monthly Medicare Part B premiumThe Medicare Part B premium is the monthly charge paid by beneficiaries for their outpatient medical care, services, and supplies. A beneficiary's premium may be uplifted by an IRMAA surcharge if their income is above....
Annual Deductible
Amerivantage Comfort's annual health plan deductible is $0.00. This does not include the deductible for the prescription drug plan (if any), which is detailed below.
Maximum Out-of-Pocket Limit
The Maximum Out-of-Pocket (MOOP) with this Amerigroup plan is $3,000 in-network. Unlike Original Medicare, Medicare Advantage plansMedicare Advantage (MA), also known as Medicare Part C, are health plans from private insurance companies that are available to people eligible for Original Medicare (Medicare Part A and Medicare Part B). must set an annual Maximum Out-of-Pocket (MOOP) limit on inpatient and outpatient healthcare services. Once you reach this amount of spending on your copayments, all of your Medicare Part A and Part B services will be covered at no additional charge for the remainder of the year. MOOP does not include monthly premiums, prescriptions, or other extra benefits.
Health Plan Out-of-Pocket Costs
The following table is a summary of the most common out-of-pocket costs you will incur if you join this Amerigroup plan:
| Healthcare Service | Member Cost |
|---|---|
| Health plan deductible | $0 |
| Maximum out-of-pocket enrollee responsibility (does not include prescription drugs) | $3,000 In-network |
| Doctor Visits | |
| Specialist | $0 copay (authorization required) |
| Wellness programs (e.g., fitness, nursing hotline) | Covered |
| Preventive care | $0 copay |
| Mental Health Services | |
| Outpatient individual therapy visit | $0 copay (authorization required) |
| Outpatient individual therapy visit with a psychiatrist | $0 copay (authorization required) |
| Outpatient group therapy visit with a psychiatrist | $0 copay (authorization required) |
| Inpatient hospital - psychiatric | $175 per day for days 1 through 5 $0 per day for days 6 through 90 (authorization required) |
| Rehabilitation Services | |
| Occupational therapy visit | $0 copay (authorization required) |
| Medical Equipment / Supplies | |
| Durable medical equipmentDurable medical equipment (DME) is equipment that is designed to last and can be used repeatedly. It is suitable for home use and includes wheelchairs, oxygen equipment, and hospital beds. (e.g., wheelchairs, oxygen) | 0-20% coinsuranceCoinsurance is a percentage of the total you are required to pay for a medical service. per item (authorization required) |
| Prosthetics (e.g., braces, artificial limbs) | 0-20% coinsurance per item (authorization required) |
| Diagnostic Procedures / Lab Services / Imaging | |
| Diagnostic radiology services (e.g., MRI) | $0-150 copay (authorization required) |
| Outpatient x-rays | $0 copay (authorization required) |
| Diagnostic tests and procedures | $0 copay (authorization required) |
| Medicare Part BMedicare Part B is medical coverage for people with Original Medicare benefits. It covers doctor visits, preventative care, tests, durable medical equipment, and supplies. Medicare Part B pays 80 percent of most medically necessary healthcare services. Drugs | |
| Chemotherapy | 20% coinsurance (authorization required) |
| Foot Care (podiatry Services) | |
| Routine foot care | $0 copay (authorization required, limits may apply) |
| Hearing | |
| Hearing aids | $0 copay (authorization required, limits may apply) |
| Fitting/evaluation | $0 copay (authorization required, limits may apply) |
| Preventive Dental | |
| Dental x-ray(s) | $0 copay (limits may apply) |
| Fluoride treatment | $0 copay (limits may apply) |
| Oral exam | $0 copay (limits may apply) |
| Comprehensive Dental | |
| Extractions | Not covered |
| Prosthodontics, other oral/maxillofacial surgery, other services | Not covered |
| Non-routine services | Not covered |
| Periodontics | Not covered |
| Restorative services | Not covered |
| Diagnostic services | Not covered |
| Vision | |
| Eyeglasses (frames and lenses) | $0 copay (limits may apply) |
| Eyeglass frames | $0 copay (limits may apply) |
| Routine eye exam | $0 copay (limits may apply) |
| Eyeglass lenses | $0 copay (limits may apply) |
| Other | Not covered |
| Upgrades | Not covered |
| Emergency Care / Urgent Care | |
| Urgent care | $0 copay |
| Ground ambulance | $195 copay |
| Inpatient hospital coverage | $175 per day for days 1 through 5 $0 per day for days 6 through 90 |
| Outpatient hospital coverage | $0-175 copay per visit |
| Skilled Nursing Facility | $0 copay per stay |
| Optional supplemental benefits | Yes |
Feel free to download our Amerivantage Comfort Summary of Benefits information.
Prescription Drug Plan Costs & Benefits
Amerivantage Comfort 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.
Enhanced plans generally have higher monthly premiums than basic benefit plans but offer more benefits. For example, many enhanced PDPs do not have an annual deductible, may offer additional coverage during the coverage gap (aka, "donut hole"), and may have a broader list of supported drugs, known as a formularyA formulary is a list of prescription drugs covered by a prescription drug plan or another insurance plan offering prescription drug benefits. Medications not on a plan's formulary are generally not covered.. Some enhanced PDPs even cover excluded drugs. It's important to remember that benefits vary from plan to 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 subsidySocial Security's Low-Income Subsidy (LIS) program helps Medicare beneficiaries pay for their Medicare Part D prescription drugs by paying some of the costs. Also known as "Extra Help", beneficiaries who qualify for LIS receive premium... (LIS) assistance. 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 |
| Part D Premium with 75% LIS Assistance: | $0.00 |
| Part D Premium with 50% LIS Assistance: | $0.00 |
| Part D Premium with 25% LIS Assistance: | $0.00 |
For more information about the Low-Income Subsidy (aka, "Extra Help") program, 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 Amerigroup begins paying its share.
Prescription Drug Plan Out-of-Pocket Costs
In addition to the plan's monthly premium and deductible, Amerivantage Comfort has copayments (a fixed dollar amount) and/or coinsurances (a percentage amount) that you must pay when you pick up your prescriptions. The following table shows you those costs.
| Tier | Preferred | Standard |
|---|---|---|
| 1 (Preferred Generic) | N/A | $0.00 copay |
| 2 (Generic) | N/A | $7.50 copay |
| 3 (Preferred Brand) | N/A | $40.00 copay |
| 4 (Non-Preferred Drug) | N/A | $85.00 copay |
| 5 (Specialty Tier) | N/A | 33% |
| 6 (Select Care Drugs) | N/A | $0.00 copay |
CMS Rating Marks and Our Review
Each year Medicare rates I-SNP plans, like this one, in nine major categories. These ratings are designed to help you understand the quality of care and service you can expect if you qualify and choose to join Amerivantage Comfort.
On most measures, this HMO plan performs well. But it's good to know where it could use some improvement. From MedicareWire's perspective, Amerivantage Comfort does an average job keeping plan members healthy through preventive care measures, including screenings, tests, and vaccines. When it comes to helping members manage their chronic health conditions, this plan does an average job. We do not have enough information from this plan to rate member experience. 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.
| CMS Measure | Star Rating |
|---|---|
| 2023 Overall Rating | |
| Staying Healthy: Screenings, Tests, Vaccines | |
| Managing Chronic (Long Term) Conditions | |
| Member Experience with Health Plan | Not enough data available |
| 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 | Not enough data available |
| Drug Safety and Accuracy of Drug Pricing |
How to Qualify to Enroll in
Amerivantage Comfort
To be eligible to enroll in Amerivantage Comfort, you must meet three requirements:
- You are eligible for Medicare;
- You live in Maricopa County (the plan’s service area); and
- You require the level of care provided in an institutionalized setting, such as a long-term care nursing facility, for 90 days or more.
If you live at home and require an equivalent level of skilled care, you may be eligible for an Institutional Equivalent Special Needs Plan (IE-SNP).
Before joining Amerivantage Comfort, consider these questions:
- Does the plan's provider network include my nursing home or home care provider?
- What costs should I expect with my coverage (premiums, deductibles, copayments)?
- Is there an annual limit on my out-of-pocket costs?
- Will I be able to use my doctors? Are they in the plan's network?
- Are the plan's in-network providers and facilities in convenient locations?
- Does the plan provide coverage for services I receive from out-of-network providers?
- Do I need a referral to see a specialist?
- Are my medications on the Part D plan's formulary?
- What special accommodations does the plan make for persons with disabilities?
- What special language and cultural accommodations does the plan make?
Additional I-SNP Plan Options
Here are some additional Medicare SNP plans in Maricopa County (I-SNPs) that might be worth reviewing:
Contact Amerigroup
| Plan Website: | http://shop.amerigroup.com/medicare |
|---|---|
| Formulay Information: | http://www.myamerigroup.com/medicare |
| Pharmacy Information: | Amerigroup Pharmacy Page |
| Prospective Members: | (855)593-0913 |
| TTY Users: | (711)- |
If you qualify for Medicare 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.
Citations & References
- Amerigroup, http://shop.amerigroup.com/medicare, Last Accessed October 13, 2022
- MedicaidMedicaid is a public health insurance program that provides health care coverage to low-income families and individuals in the United States..gov, "Medicaid & CHIP in Arizona", Last Accessed October 15, 2022
- CMS.gov, "Institutional Special Needs Plans (I-SNPs)", Last Accessed June 29, 2022
- CMS.gov, Landscape Source Files, Last Accessed October 26, 2021
- CMS.gov, Medicare Part C & D Performance, Last Accessed October 6, 2021
- CMS.gov, Plan Benefits Package, Last Accessed October 4, 2021
The Medicare Special Needs Plans in Maricopa County, Arizona for 2023 information on this page was last updated on .