2024 Senior Advantage Medicare Medicaid Plan 1 D-SNP: H1170-008-0 for Coweta County, GA
What is Plan H1170-008-0 by Kaiser Permanente?
Senior Advantage Medicare Medicaid Plan 1 (HMO D-SNP) is a 2024 Medicare Advantage Special Needs Plan from Kaiser Permanente. Delivery of healthcare services and costs are significantly different than in Original Medicare, and the plan offers additional benefits that are not included with Medicare Part A and Part B.
You must meet all qualification requirements to join this D-SNP plan.
Plan Basics | |
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Plan ID: | H1170-008-0 |
Plan Type: | HMO |
Plan Year: | 2024 |
Premium: | $42.30/mo Plus your Part B premium. |
Health Plan Deductible: | $0.00 |
Out-of-Pocket Maximum: | /yr |
Part B Reduction: | $0.00/mo |
Drug Plan Benefit: | Enhanced $545.00 deductible |
Rx Gap Coverage: | {gap} |
Supplemental Benefits: | Dental, Vision, Hearing |
Availability: | Coweta County, GA |
Insured By: | Kaiser Permanente |
Summary of Benefits |
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Health Plan Costs & Benefits
Senior Advantage Medicare Medicaid Plan 1 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, Senior Advantage Medicare Medicaid Plan 1 does allow out-of-network care for emergencies and out-of-area dialysis.
The following table is a summary of the most common out-of-pocket costs you will incur if you join this Kaiser Permanente plan:
Healthcare Service | Member Cost |
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Doctor Visits (In-Network) | |
Primary: | $0 Copay |
Specialist: | $0 Copay Referral Required |
Wellness programs (e.g., fitness, nursing hotline): | |
Preventive care: | $0 Copay |
Foot Care (In-Network) | |
Foot exams and treatment (Medicare-covered): | $0 Copay Referral Required |
Routine foot care: | $0 |
Chiropractic Care (In-Network) | |
Medicare-covered chiropractic care: | $0 Copay |
Routine chiropractic care: | $0 Copay |
Emergency Care / Urgent Care | |
Emergency room care: | $20 Copay |
Urgent care: | $0 Copay |
Ground ambulance: | $25 Copay |
Inpatient hospital coverage: | $12.00 per stay |
Outpatient hospital coverage: | $0 Copay Authorization Required |
Skilled Nursing Facility: | $0.00 per day for days 1 through 100 |
Optional supplemental benefits: | Not Covered |
Mental Health Services (In-Network) | |
Outpatient individual therapy visit with a psychiatrist: | $0 Copay |
Outpatient group therapy visit with a psychiatrist: | $0 Copay |
Inpatient hospital - psychiatric: | $12.00 per stay |
Outpatient group therapy visit: | $0 Copay |
Outpatient individual therapy visit: | $0 |
Rehabilitation Services (In-Network) | |
Physical therapy and speech and language therapy visit: | $0 Copay Authorization Required, Referral Required |
Occupational therapy visit: | $0 Copay Referral Required |
Medical Equipment / Supplies (In-Network) | |
Diabetes supplies: | $0 Copay |
Durable medical equipment (e.g., wheelchairs, oxygen): | $0 Copay Authorization Required |
Prosthetics (e.g., braces, artificial limbs): | $0 |
Diagnostic Procedures / Lab Services / Imaging (In-Network) | |
Diagnostic radiology services (e.g., MRI): | $0 Copay Authorization Required, Referral Required |
Lab services: | $0 Copay Authorization Required, Referral Required |
Outpatient x-rays: | $0 Copay Authorization Required, Referral Required |
Diagnostic tests and procedures: | $0 Copay Authorization Required, Referral Required |
Medicare Part B Drugs (In-Network) | |
Chemotherapy: | $47 Copay |
Other Part B drugs (Medicare-covered) | $47 Copay |
Feel free to download our Senior Advantage Medicare Medicaid Plan 1 Summary of Benefits information.
Supplemental Health Plan Benefits (H1170-008-0)
The following is a summary of the supplemental benefits Kaiser Permanente 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) | Not Covered |
Diagnostic services (In-Network) | Covered |
Extractions (In-Network) | Covered |
Endodontics (In-Network) | Not Covered |
Restorative services (In-Network) | Covered |
Prosthodontics, other oral/maxillofacial surgery, other services (In-Network) | Covered |
Hearing | |
Fitting/evaluation (In-Network) | Covered Limits may apply |
Hearing aids (In-Network) | Not Covered |
Hearing exam (In-Network) | Not Covered |
Vision | Maximum vision benefit: | $575.00 Every two years |
Eyeglasses (frames and lenses) (In-Network) | Covered Limits may apply |
Routine eye exam (In-Network) | $0 Copay |
Contact lenses (In-Network) | Covered Limits may apply |
Additional Supplemental Benefits
None specified.
Prescription Drug Plan Costs & Benefits
Senior Advantage Medicare Medicaid Plan 1 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. The following table outlines the prescription drug plan premium details of this plan.
Basic Part D Premium: | $42.30 |
Supplemental Part D Premium: | $0.00 |
Total Part D Premium: | $42.30 |
Part D Premium with Full 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 $545.00. This is the amount you must pay at the pharmacy before Kaiser Permanente begins paying its share.
NOTE: The deductible does not apply to one or more drug tiers in this plan (see "Prescription Drug Plan Out-of-Pocket Costs" below).
Prescription Drug Plan Out-of-Pocket Costs
In addition to the plan's monthly premium and deductible, Senior Advantage Medicare Medicaid Plan 1 has out-of-pocket costs that you must pay when you pick up your prescriptions. The following table shows you those costs.
Drug Tier | Preferred | Standard |
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1 (Preferred Generic) | N/A | $0.00 copay (deductible does not apply) |
2 (Generic) | N/A | $14.00 copay |
3 (Preferred Brand) | N/A | $47.00 copay |
4 (Non-Preferred Drug) | N/A | $100.00 copay |
5 (Specialty Tier) | N/A | 25% |
6 (Vaccines ($0 cost sharing)) | N/A | $0.00 copay |
CMS Rating Marks
Each year Medicare rates D-SNP plans, using a 5-star rating system, 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 Senior Advantage Medicare Medicaid Plan 1.
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 |
How to Qualify to Enroll in
Senior Advantage Medicare Medicaid Plan 1
To qualify for enrollment in Senior Advantage Medicare Medicaid Plan 1 in Coweta County, you must be eligible for both Medicare and Medicaid. To be eligible for Medicare, you must be age 65 or older, or have Social Security Disability Insurance for 24 months. To be eligible for Medicaid, your income and assets must be at or below Georgia's state thresholds.
Before enrolling in Senior Advantage Medicare Medicaid Plan 1, or any other dual-eligible SNP, be sure to ask the following questions:
- What costs should I expect to pay out-of-pocket (premiums, deductibles, copayments)?
- 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 if I can't afford my medications?
- What special accommodations does the plan make for persons with disabilities?
- Does the plan offer free meal delivery after a stay in the hospital?
- What help is offered for caregivers? Is adult day care covered?
- Does the plan offer a prepaid card for over the counter medications and covered groceries?
Additional D-SNP Plan Options
Here are some additional Medicare SNP plans that might be worth reviewing:
Contact Kaiser Permanente
Plan Website: | http://kp.org/medicare |
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Formulay Information: | http://kp.org/directory |
Pharmacy Information: | Kaiser Permanente Pharmacy Page |
Prospective Members: | (877)408-3493 |
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
- Kaiser Permanente, http://kp.org/medicare, Last Accessed October 13, 2023
- Medicaid.gov, "Medicaid & CHIP in Georgia", Last Accessed January 4, 2024
- CMS.gov, "Dual Eligible Special Needs Plans (D-SNPs)", Last Accessed January 20, 2023
- CMS.gov, Landscape Source Files, Last Accessed January 2, 2024
- CMS.gov, Medicare Part C & D Performance, Last Accessed January 2, 2024
- CMS.gov, Plan Benefits Package, Last Accessed January 3, 2024