Vantage DUAL PLUS (D-SNP HMO-POS), Washington Parish, LA
Plan H5576-019-0, Vantage DUAL PLUS, is a D-SNP Special Needs Plan, with a HMO-POS provider network. 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.
CMS rated this plan 4.5 (Good+) out of 5 stars. See MedicareWire's review below. You must meet all qualification requirements to join this D-SNP plan.
GET NOTIFIED: 2024 Medicare Special Needs Plan Notification.
What You Need to Know
- Vantage DUAL PLUS is a Medicare Advantage SNP plan available to people on Medicare who also qualify for Louisiana state Medicaid benefits (dual-eligible).
- This is not a zero-dollar D-SNP cost-sharing plan. Members have small copays on some Medicare-approved healthcare services.
- To qualify to join this D-SNP, you must live in Washington Parish and be enrolled in Medicare Part A and Part B, and qualify for full Medicaid benefits.
- It is a HMO-POS style private health plan that includes Medicare Part D prescription drug benefits.
- The annual Part D deductible is $505.00. You pay this amount before cost-sharing begins.
- Plan members who qualify for Medicare's "Extra Help" program will also get full or partial assistance with their Medicare Part D monthly premium, annual deductible, and prescription copayments.
- As required, Vantage DUAL PLUS gives its members the coverage benefits included with Medicare Parts A and B (aka, Original Medicare), but also includes additional benefits.
- If you don't qualify, compare Medicare Advantage plans available in Washington Parish, Louisiana. Another way to get more coverage is with one of the many Louisiana Medigap plans and a stand-alone Part D plan for Arizona residents.
- 2024 costs and benefits for Vantage DUAL PLUS will be available in early October. Get Notification.
| H5576-019-0 Plan Basics | |
|---|---|
| Plan ID: | H5576-019-0 |
| Plan Type: | D-SNP |
| Network Type: | HMO-POS |
| Plan Year: | 2023 |
| Premium: | $38.40/mo Plus your Part B premium. |
| Health Plan Deductible: | $0.00 |
| Out-of-Pocket Maximum: | $7,550 In-network |
| Drug Plan Benefit: | Basic $505.00 deductible |
| Rx Gap Coverage: | No |
| Supplemental Benefits: | Dental, Vision, Hearing |
| Availability: | Washington Parish, LA |
| Insured By: | Vantage Health Plan |
Health Plan Costs & Benefits
Vantage DUAL PLUS is an HMO-POS (point-of-sale) plan. HMO-POS plans offer the same features as a Health Maintenance Organization (HMO) plan, however, there is one major difference. HMO-POS plans allow members to access healthcare providers outside the plan's network to receive some or all of their services. In most cases, a member will need to get a referral from their physician to go out of the plan's network. Plus, there are separate deductibles for in-network and out-of-network services.
Premiums, deductibles, 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
Vantage DUAL PLUS's total monthly premium in Washington Parish is $38.40. This includes your prescription coverage, as well. Plus, you must continue to pay your monthly Medicare Part B premium.
Annual Deductible
Vantage DUAL PLUS'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 Vantage Health Plan plan is $7,550 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 Vantage Health Plan plan:
| Healthcare Service | Member Cost |
|---|---|
| Health plan deductible | $0 or $500 Out-of-network |
| Maximum out-of-pocket enrollee responsibility (does not include prescription drugs) | $7,550 In-network |
| Doctor Visits | |
| Primary (In-Network) | 0% or 20% coinsurance per visit |
| Primary (Out-of-Net) | 50% coinsurance per visit |
| Specialist (Out-of-Net) | 50% coinsurance per visit (authorization required) |
| Wellness programs (e.g., fitness, nursing hotline) | Covered |
| Preventive care | $0 copay |
| Mental Health Services | |
| Outpatient individual therapy visit (In-Network) | 0% or 20% coinsurance (authorization required) |
| Outpatient group therapy visit (In-Network) | 0% or 20% coinsurance (authorization required) |
| Inpatient hospital - psychiatric (Out-of-Net) | 50% per stay (authorization required) |
| Outpatient individual therapy visit with a psychiatrist (In-Network) | 0% or 20% coinsurance (authorization required) |
| Outpatient individual therapy visit (Out-of-Net) | 50% coinsurance (authorization required) |
| Outpatient group therapy visit (Out-of-Net) | 50% coinsurance (authorization required) |
| Outpatient group therapy visit with a psychiatrist (In-Network) | 0% or 20% coinsurance (authorization required) |
| Inpatient hospital - psychiatric (In-Network) | In 2023 the amounts for each benefit period are $0 or: $1,600 deductible for days 1 through 60 $400 cop (authorization required) |
| Outpatient individual therapy visit with a psychiatrist (Out-of-Net) | 50% coinsurance (authorization required) |
| Rehabilitation Services | |
| Physical therapy and speech and language therapy visit (Out-of-Net) | 50% coinsurance (authorization required) |
| Physical therapy and speech and language therapy visit (In-Network) | 0% or 20% coinsurance (authorization required) |
| Occupational therapy visit (Out-of-Net) | 50% coinsurance (authorization required) |
| Medical Equipment / Supplies | |
| Prosthetics (e.g., braces, artificial limbs) (Out-of-Net) | 50% coinsurance per item (authorization required) |
| Diabetes supplies (In-Network) | 0% or 0-20% coinsurance per item (authorization required) |
| Prosthetics (e.g., braces, artificial limbs) (In-Network) | 0% or 20% coinsurance per item (authorization required) |
| Durable medical equipment (e.g., wheelchairs, oxygen) (Out-of-Net) | 50% coinsurance per item (authorization required) |
| Durable medical equipment (e.g., wheelchairs, oxygen) (In-Network) | 0% or 20% coinsurance per item (authorization required) |
| Diagnostic Procedures / Lab Services / Imaging | |
| Lab services (Out-of-Net) | 50% coinsurance (authorization required) |
| Diagnostic radiology services (e.g., MRI) (In-Network) | 0% or 20% coinsurance (authorization required) |
| Diagnostic tests and procedures (Out-of-Net) | 50% coinsurance (authorization required) |
| Lab services (In-Network) | $0 copay (authorization required) |
| Diagnostic tests and procedures (In-Network) | 0% or 20-25% coinsurance (authorization required) |
| Diagnostic radiology services (e.g., MRI) (Out-of-Net) | 50% coinsurance (authorization required) |
| Outpatient x-rays (Out-of-Net) | 50% coinsurance (authorization required) |
| Medicare Part B Drugs | |
| Other Part B drugs (Out-of-Net) | 50% coinsurance (authorization required) |
| Chemotherapy (In-Network) | 0% or 20% coinsurance (authorization required) |
| Other Part B drugs (In-Network) | 0% or 20% coinsurance (authorization required) |
| Foot Care (podiatry Services) | |
| Routine foot care | Not covered |
| Foot exams and treatment (Out-of-Net) | 50% coinsurance (authorization required) |
| Hearing | |
| Hearing aids (In-Network) | $0 copay (limits may apply) |
| Fitting/evaluation (Out-of-Net) | $0 copay (authorization required, limits may apply) |
| Hearing aids (Out-of-Net) | $0 copay (limits may apply) |
| Hearing exam (In-Network) | 0% or 20% coinsurance (authorization required) |
| Hearing exam (Out-of-Net) | 50% coinsurance (authorization required) |
| Preventive Dental | |
| Dental x-ray(s) (In-Network) | $0 copay (limits may apply) |
| Cleaning (In-Network) | $0 copay (limits may apply) |
| Dental x-ray(s) (Out-of-Net) | $0 copay (limits may apply) |
| Oral exam (Out-of-Net) | $0 copay (limits may apply) |
| Oral exam (In-Network) | $0 copay (limits may apply) |
| Fluoride treatment (Out-of-Net) | $0 copay (limits may apply) |
| Cleaning (Out-of-Net) | $0 copay (limits may apply) |
| Comprehensive Dental | |
| Restorative services (Out-of-Net) | $0 copay (authorization required, limits may apply) |
| Extractions (Out-of-Net) | $0 copay (authorization required, limits may apply) |
| Endodontics (Out-of-Net) | $0 copay (authorization required, limits may apply) |
| Diagnostic services (Out-of-Net) | $0 copay (authorization required, limits may apply) |
| Non-routine services (Out-of-Net) | $0 copay (authorization required, limits may apply) |
| Periodontics (In-Network) | $0 copay (authorization required, limits may apply) |
| Periodontics (Out-of-Net) | $0 copay (authorization required, limits may apply) |
| Diagnostic services (In-Network) | $0 copay (authorization required, limits may apply) |
| Non-routine services (In-Network) | $0 copay (authorization required, limits may apply) |
| Prosthodontics, other oral/maxillofacial surgery, other services (Out-of-Net) | $0 copay (authorization required, limits may apply) |
| Restorative services (In-Network) | $0 copay (authorization required, limits may apply) |
| Prosthodontics, other oral/maxillofacial surgery, other services (In-Network) | $0 copay (authorization required, limits may apply) |
| Endodontics (In-Network) | $0 copay (authorization required, limits may apply) |
| Vision | |
| Upgrades (Out-of-Net) | $0 copay (limits may apply) |
| Upgrades (In-Network) | $0 copay (limits may apply) |
| Routine eye exam (In-Network) | $0 copay (limits may apply) |
| Eyeglasses (frames and lenses) (Out-of-Net) | $0 copay (limits may apply) |
| Eyeglass lenses (Out-of-Net) | $0 copay (limits may apply) |
| Eyeglass frames (In-Network) | $0 copay (limits may apply) |
| Eyeglass lenses (In-Network) | $0 copay (limits may apply) |
| Contact lenses (Out-of-Net) | $0 copay (limits may apply) |
| Eyeglass frames (Out-of-Net) | $0 copay (limits may apply) |
| Contact lenses (In-Network) | $0 copay (limits may apply) |
| Routine eye exam (Out-of-Net) | 50% coinsurance (limits may apply) |
| Eyeglasses (frames and lenses) (In-Network) | $0 copay (limits may apply) |
| Emergency Care / Urgent Care | |
| Emergency | $0 or $90 copay per visit (always covered) |
| Ground ambulance | 50% coinsurance |
| Inpatient hospital coverage | In 2023 the amounts for each benefit period are $0 or: $1,600 deductible for days 1 through 60 $400 cop |
| Outpatient hospital coverage | 0% or 20% coinsurance per visit |
| Skilled Nursing Facility | In 2023 the amounts for each benefit period are $0 or: $0 copay for days 1 through 20 $200 copay per da |
| Optional supplemental benefits | No |
Feel free to download our Vantage DUAL PLUS Summary of Benefits information.
Prescription Drug Plan Costs & Benefits
Vantage DUAL PLUS includes an basic benefit Medicare Part D plan (PDP). This simply means that the plan covers the minimum amount required by the Centers for Medicare & Medicaid Services, whereas enhanced benefit plans cover more.
Basic plans typically have less cost-sharing by the plan than plans with an enhanced benefit. But, close to a third of all enhanced plans charge more than the average for preferred brand name drugs, and over 50% charge more for non-preferred brand drugs. For most people, a basic plan is their best bet, due to lower premiums and lower cost-sharing, even if the plan has a deductible.
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: | $38.40 |
| Supplemental Part D Premium: | $0.00 |
| Total Part D Premium: | $38.40 |
| Part D Premium with Full LIS Assistance: | $0.00 |
| Part D Premium with 75% LIS Assistance: | $9.60 |
| Part D Premium with 50% LIS Assistance: | $19.20 |
| Part D Premium with 25% LIS Assistance: | $28.80 |
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 Vantage Health Plan begins paying its share.
Prescription Drug Plan Out-of-Pocket Costs
In addition to the plan's monthly premium and deductible, Vantage DUAL PLUS 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 |
|---|---|---|
| $0 copay on all covered generic and brand-name prescriptions. | ||
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 Vantage DUAL PLUS.
On its way to 5 stars, this D-SNP plan is worth considering. Here's why. From MedicareWire's perspective, Vantage DUAL PLUS does an average job keeping plan members healthy through preventive care measures, including screenings, tests, and vaccines. This plan is good at managing its member's chronic (long-term) health conditions. Overall, members say their experience with this Vantage Health Plan D-SNP plan is excellent. Complaints and changes in plan performance are one way we can measure quality, and this plan scores good at both. 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 | |
| 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
Vantage DUAL PLUS
To qualify for enrollment in Vantage DUAL PLUS 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 Vantage DUAL PLUS, 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:
- Peoples Health Secure Health
- Wellcare Dual Access Medicare
- Wellcare Dual Freedom Access
- Aetna Medicare Dual Preferred Plan
- UnitedHealthcare Dual Complete Choice
Contact Vantage Health Plan
Call 1-855-728-0510 (TTY 711) to speak with a licensed insurance agent (Mon-Fri, 8am-9pm , Sat 8am-8pm EST) and learn more about this Special Needs Plan and other plans on this site. You may also Enroll Online using our safe and secure online enrollment website or take advantage of the following plan resources:
| Plan Website: | http://www.VantageMedicare.com |
|---|---|
| Formulay Information: | http://www.VantageMedicare.com |
| Pharmacy Information: | Vantage Health Plan Pharmacy Page |
| Prospective Members: | (866)704-0109 |
| TTY Users: | (866)524-5144 |
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.
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, Centene Corporation, Dean Health Plan, Devoted Health, GlobalHealth, Health Care Service Corporation, Cigna-HealthSpring, Humana, Molina Healthcare, Mutual of Omaha, Oscar Health Insurance, Premera Blue Cross, Medica Central Health Plan, SCAN Health Plan, Scott and White Health Plan now part of Baylor Scott & White Health, and UnitedHealthcare.
Citations & References
- Vantage Health Plan, http://www.VantageMedicare.com, 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