Healthy Blue Enhanced Care (D-SNP HMO) 2023 Washington Parish, Louisiana Medicare Advantage Special Needs Plan
Healthy Blue Enhanced Care is a 2023 Medicare Special Needs Plan (D-SNP) for people who live in Washington Parish, Louisiana. This Healthy Blue HMO plan is required to provide all of the same 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. and includes some additional benefits, 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. may be different.
CMS rated this plan 3.0 (Average) out of 5 stars.
Key Takeaways
- Healthy Blue Enhanced Care is a HMO health plan for dual-eligibleDual-eligible beneficiaries are those who receive both Medicare and Medicaid benefits. It includes beneficiaries enrolled in Medicare Part A and/or Part B while receiving full Medicaid and/or financial assistance through a Medicare Savings Program.... (Medicare and MedicaidMedicaid is a public health insurance program that provides health care coverage to low-income families and individuals in the United States.) beneficiaries.
- To qualify, you must have both 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, you must live in the plan's service area (Washington Parish), and you must qualify for full Medicaid.
- It includes prescription drug coverage (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...).
- The annual Part D deductible is $505.00. You pay this amount before cost-sharing begins.
- People who qualify for Medicare "Extra Help," can get additional assistance to help pay their Medicare Part D monthly premium, deductible, and copaymentsA copayment, also known as a copay, is a set dollar amount you are required to pay for a medical service..
- The plan offers the same health insurance benefits as Original Medicare and some additional benefits that Original Medicare does not cover.
- If you don't qualify to join Healthy Blue Enhanced Care, you might want to compare 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). available in Washington Parish, Louisiana. Another popular option is to add one of the many Medicare supplementsMedicare Supplements are additional insurance policies that Medicare beneficiaries can purchase to cover the gaps in their Original Medicare (Medicare Part A and Medicare Part B) health insurance coverage. available in Louisiana and a stand-alone prescription drug plan.
| Plan Basics | |
|---|---|
| Plan ID: | H1947-003-0 |
| Plan Type: | D-SNP |
| Network Type: | HMO |
| Plan Year: | 2023 |
| Premium: | $16.90/mo Plus your Part B premium. |
| Health Plan Deductible: | $0.00 |
| Out-of-Pocket Maximum: | $8,300 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 $505.00 deductible |
| Rx Gap Coverage: | No |
| Supplemental Benefits: | None |
| Availability: | Washington Parish, LA |
| Insured By: | Healthy Blue |
Health Plan Costs & Benefits
Healthy Blue Enhanced Care 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, Healthy Blue Enhanced Care 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
Healthy Blue Enhanced Care's total monthly premium in Washington Parish is $16.90. 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
Healthy Blue Enhanced Care'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 Healthy Blue plan is $8,300 in-network. Unlike Original Medicare, Medicare Advantage plans 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 Healthy Blue plan:
| Healthcare Service | Member Cost |
|---|---|
| Health plan deductible | $0 |
| Maximum out-of-pocket enrollee responsibility (does not include prescription drugs) | $8,300 In-network |
| Doctor Visits | |
| Primary | $0 copay |
| Wellness programs (e.g., fitness, nursing hotline) | Covered |
| Preventive care | $0 copay |
| Mental Health Services | |
| Inpatient hospital - psychiatric | $0 or $550 per day for days 1 through 3 $0 per day for days 4 through 90 (authorization required) |
| Outpatient individual therapy visit | $0 or $25 copay (authorization required) |
| Outpatient group therapy visit with a psychiatrist | $0 or $25 copay (authorization required) |
| Outpatient individual therapy visit with a psychiatrist | $0 or $25 copay (authorization required) |
| Rehabilitation Services | |
| Occupational therapy visit | $0 or $25 copay (authorization required) |
| Medical Equipment / Supplies | |
| Prosthetics (e.g., braces, artificial limbs) | 0% or 20% coinsuranceCoinsurance is a percentage of the total you are required to pay for a medical service. per item (authorization required) |
| Diabetes supplies | $0 copay |
| Diagnostic Procedures / Lab Services / Imaging | |
| Diagnostic radiology services (e.g., MRI) | $0 or $100-175 copay (authorization required) |
| Diagnostic tests and procedures | $0 or $0-100 copay (authorization required) |
| Outpatient x-rays | $0 or $50-90 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 | |
| Other Part B drugs | 0% or 20% coinsurance (authorization required) |
| Foot Care (podiatry Services) | |
| Foot exams and treatment | $0 or $0-25 copay (authorization required) |
| Hearing | |
| Hearing aids | $0 copay (authorization required, limits may apply) |
| Hearing exam | $0 or $25 copay (authorization required) |
| Preventive Dental | |
| Dental x-ray(s) | $0 copay (limits may apply) |
| Fluoride treatment | $0 copay (limits may apply) |
| Cleaning | $0 copay (limits may apply) |
| Comprehensive Dental | |
| Restorative services | $0 copay (authorization required, limits may apply) |
| Endodontics | $0 copay (authorization required, limits may apply) |
| Non-routine services | $0 copay (authorization required, limits may apply) |
| Diagnostic services | $0 copay (authorization required, limits may apply) |
| Extractions | $0 copay (authorization required, limits may apply) |
| Prosthodontics, other oral/maxillofacial surgery, other services | $0 copay (authorization required, limits may apply) |
| Vision | |
| Eyeglass lenses | $0 copay (limits may apply) |
| Contact lenses | $0 copay (limits may apply) |
| Eyeglass frames | $0 copay (limits may apply) |
| Upgrades | $0 copay (limits may apply) |
| Other | Not covered |
| Routine eye exam | $0 copay (authorization required, limits may apply) |
| Emergency Care / Urgent Care | |
| Emergency | $0 or $90 copay per visit (always covered) |
| Ground ambulance | 0% or 20% coinsurance |
| Inpatient hospital coverage | $0 or $600 per day for days 1 through 3 $0 per day for days 4 through 90 |
| Outpatient hospital coverage | $0 or $50 copay or 0-20% coinsurance per visit |
| Skilled Nursing Facility | In 2023 the amounts for each benefit periodA benefit period is a method used in Original Medicare to measure a beneficiaries use of hospital and skilled nursing facility (SNF) services. With each new benefit period, the beneficiary is charged a new benefit... are $0 or: $0 copay for days 1 through 20 $200 copay per da |
| Optional supplemental benefits | No |
Feel free to download our Healthy Blue Enhanced Care Summary of Benefits information.
Prescription Drug Plan Costs & Benefits
Healthy Blue Enhanced Care 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: | $16.90 |
| Supplemental Part D Premium: | $0.00 |
| Total Part D Premium: | $16.90 |
| Part D Premium with Full LIS Assistance: | $0.00 |
| Part D Premium with 75% LIS Assistance: | $4.20 |
| Part D Premium with 50% LIS Assistance: | $8.40 |
| Part D Premium with 25% LIS Assistance: | $12.70 |
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 $505.00. This is the amount you must pay at the pharmacy before Healthy Blue begins paying its share.
Prescription Drug Plan Out-of-Pocket Costs
In addition to the plan's monthly premium and deductible, Healthy Blue Enhanced Care 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) | $10.00 copay | $10.00 copay |
| 2 (Generic) | $20.00 copay | $20.00 copay |
| 3 (Preferred Brand) | $47.00 copay | $47.00 copay |
| 4 (Non-Preferred Drug) | $95.00 copay | $100.00 copay |
| 5 (Specialty Tier) | 25% | 25% |
| 6 (Select Care Drugs) | $10.00 copay | $10.00 copay |
CMS Rating Marks and Our Review
Each year Medicare rates D-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 Healthy Blue Enhanced Care.
Most D-SNP plans get average marks, including this one. From MedicareWire's viewpoint, anyone looking for a D-SNP HMO plan that prioritizes preventive health (i.e., screenings, tests, vaccines, etc.) may be disapointed with Healthy Blue Enhanced Care because the plan's score is below average. When it comes to helping members manage their chronic health conditions, this plan does an average job. The member experience with this Healthy Blue plan is average. When it comes to complaints and changes in performance, this plan is below average.
| CMS Measure | Star Rating |
|---|---|
| 2023 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 | Not enough data available |
| 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
Healthy Blue Enhanced Care
To qualify for enrollment in Healthy Blue Enhanced Care in Washington Parish, 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 Louisiana's state thresholds.
Before enrolling in Healthy Blue Enhanced Care, 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 in Washington Parish (D-SNPs) that might be worth reviewing:
- Wellcare Dual Freedom Access
- Wellcare Dual Pinnacle Liberty
- UnitedHealthcare Dual Complete Choice
- Peoples Health Secure Complete
- Peoples Health Secure Health
Contact Healthy Blue
| Plan Website: | http://shop.healthybluela.com/medicare |
|---|---|
| Formulay Information: | https://shop.anthem.com/medicare |
| Pharmacy Information: | Healthy Blue Pharmacy Page |
| Prospective Members: | (855)593-0912 |
| 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
- Healthy Blue, http://shop.healthybluela.com/medicare, Last Accessed October 13, 2022
- Medicaid.gov, "Medicaid & CHIP in Louisiana", Last Accessed January 20, 2023
- CMS.gov, "Dual Eligible Special Needs Plans (D-SNPs)", Last Accessed January 20, 2023
- CMS.gov, Landscape Source Files, Last Accessed January 21, 2023
- CMS.gov, Medicare Part C & D Performance, Last Accessed January 21, 2023
- CMS.gov, Plan Benefits Package, Last Accessed January 21, 2023
The Medicare Special Needs Plans in Washington Parish, Louisiana for 2023 information on this page was last updated on .