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Medicare Advantage 2017

Memorial Hermann Advantage HMO Plan

Memorial Hermann Advantage HMO is a health plan with a Medicare contract available to Medicare-eligible individuals who reside in Harris, Fort Bend or Montgomery counties in Texas.

Benefits of Memorial Hermann Advantage HMO

The Memorial Hermann Advantage HMO plan offers the same health coverage benefits as Original Medicare, plus enhanced benefits like:

$0 monthly plan premiums on HMO and PPO plans
Enjoy $0 monthly plan premiums as long as you continue to pay your Medicare Part B premium.

No referrals needed to see any specialist
Gain access to our full range of specialists without a referral from your primary care physician.

National/worldwide urgent care and emergency coverage
Travel with confidence knowing that Memorial Hermann Advantage plans have you covered no matter where you are.

Prescription drug coverage (Part D)
Control drug costs with low copays for generics and name-brands, along with access to convenient mail delivery services.

Vision and hearing benefits
Get annual hearing and eye exam coverage plus $250 toward hearing aids every year.

Maximum out-of-pocket costs
Limit the annual financial liability of your healthcare costs.

Preventive screenings and services at no additional cost
Avoid major medical issues with no-cost preventive screenings for glaucoma, prostate cancer, breast cancer and more.

Fitness benefits and incentives
Enjoy a range of incentives and benefits including no-cost memberships at local fitness centers like the YMCA. Learn more >

Access to a vast network of hospitals and physicians
Serving Greater Houston with 17 hospitals, numerous specialty institutes and more than 3,000 physicians.

Expand coverage with the Memorial Hermann Advantage Pack
For an additional monthly fee, you'll get benefits such as comprehensive dental coverage, expanded vision benefits, and access to chiropractic services. Learn more >

The plan requires you to use doctors and other health care professionals that participate in the Memorial Hermann Advantage HMO plan’s network. With the exception of emergency situations like ER visits, urgent care stays and renal dialysis services, without authorization, neither Medicare nor Memorial Hermann Advantage HMO will pay for these services.

See the chart below for some of the costs associated with the Memorial Hermann Advantage HMO plan.



Plan BenefitMemorial Hermann
Advantage HMO
Monthly Plan Premium$0
Maximum Out-of-Pocket Limit$6,700
Inpatient Hospital$550 copay per stay
Primary Care Physician Services$5 copay
Physician Specialist Services$40 copay
Ambulatory Surgical Center$150 copay
Outpatient Hospital Services$150 copay
Skilled Nursing FacilityDays 1–20: $0 copay per day
Days 21–100: $160 copay per day
Durable Medical Equipment20% coinsurance
Lab & Diagnostic Services

$0 copay for lab services

$10 copay for procedures

Outpatient X-Rays$15 copay
Medicare-Covered Therapeutic
Radiological Services
$25 copay
Medicare-Covered Diagnostic
Radiological Services
$175 copay
Urgently Needed Care$40 copay
Emergency Care$75 copay
Home Health Care$0 copay
Annual Preventive Services: Bone
Mass Measurement, Colorectal
Screening Exam, Pneumonia &
Flu Vaccine, Screening
Mammogram, Pap Smear & Pelvic
Exam, Prostate Screening
$0 copay
Hearing Benefit**$40 copay for hearing exam and
Medicare covered visit 

$250 for hearing aids every year

Vision Benefit

Exam to diagnose and treat diseases and conditions of the eye (including yearly glaucoma screening):

$0 copay for routine eye exam performed by Optician / Optometrist.

$40 copay for routine eye exam performed by Ophthalmologist.

$50 for eyewear every year

Readmission Prevention Care***$10 copay
Part B
Prescription Drug Coverage
Memorial Hermann
Advantage HMO
All Part B Drugs Including
Chemotherapy
20% coinsurance
Part D
Prescription Drug Coverage
Memorial Hermann
Advantage HMO
Deductible$300 Deductible applies to Tiers 4-5
Initial Coverage Limit$3,700
Tier 1: Preferred Generic$5 copay for 30-day supply
Tier 2: Non-preferred Generic$15 copay for 30-day supply
Tier 3: Preferred Brand$45 copay for 30-day supply
Tier 4: Non-Preferred Brand$99 copay for 30-day supply
Tier 5: Specialty Tier Drugs27% coinsurance for 30-day supply
Mail Order Availability

 

Tier

Mail Order Copay (90 day supply)

Tier 1 (Preferred Generic)

$10

Tier 2 (Non-Preferred Generic)

$30

Tier 3 (Preferred Brand)

$90

Tier 4 (Non-Preferred Brand)

$198

Tier 5 (Specialty)

Not available

 

Coverage Gap
Most Medicare drug plans have a coverage gap (also called the “donut hole”).  This means that there’s a temporary change in what you will pay for your drugs.  The coverage gap begins after the total yearly drug cost (including what our plan has paid and what you have paid) reaches $3,700. After you enter the coverage gap, you pay 40% of the price for brand name drugs plus a portion of the dispensing fee and 51% of the price for generic drugs. Not everyone will enter the coverage gap.

 

Catastrophic Coverage RxAfter your total yearly drug costs reach $4,950, you will pay $3.30 for generic drugs and $8.25 for brand drugs or 5% coinsurance for these drugs, whichever amount is greater.

What to Consider Before Enrolling in a Memorial Hermann Advantage HMO Plan

  • You cannot enroll in a Medicare Advantage plan if you are not already enrolled in Medicare Part A and Part B. To enroll in original Medicare, visit the Social Security Administration’s website, medicare.gov. (Please note that by clicking on this link, you will be leaving Memorial Hermann Advantage website.)
  • In order to be eligible for a Memorial Hermann Advantage HMO plan, you must live within the Harris, Fort Bend or Montgomery counties in Texas.
  • If your current doctor does not participate in the Memorial Hermann Advantage HMO plan, you can talk to an authorized plan representative at (877) 258-9408 (TTY 711) to learn about other providers or to explore our PPO plan option. View a list of Memorial Hermann Advantage HMO providers, also called the Memorial Hermann Advantage HMO Provider Directory.
  • Compare Medicare Advantage plans. Use our plan comparison page to view Memorial Hermann Advantage plans side by side, and choose which one best meets your health and financial needs.

Disclaimer Information

Memorial Hermann Advantage HMO is a health plan with a Medicare contract. Enrollment in Memorial Hermann Advantage HMO depends on contract renewal.

*You must continue to pay your Medicare Part B premium.

This information is not a complete description of benefits. Contact the plan for more information. Limitations, copayments, and restrictions may apply. Benefits, premiums and/or co-payments/co-insurance may change on January 1 of each year.

The Formulary, pharmacy network, and/or provider network may change at any time. You will receive notice when necessary.

**Hearing Aids are covered under this benefit plan at $250.00 every year. There is no exclusion on hearing aid types.

***Memorial Hermann Advantage HMO will help cover the cost when non-skilled attendant care is authorized by a Care Manager.

Medicare beneficiaries may also enroll in a Memorial Hermann Advantage plan through CMS Medicare Online Enrollment Center located at medicare.gov. (Please note that by clicking on this link, you will be leaving Memorial Hermann Advantage website).


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