2022 IIHCP Community Choice (HMO)
IIHCP Community Choice (HMO) H0826-001 is a 2022 Medicare Advantage Plan or Part-C by Innovative Integrated Health Community Plans available to residents in California. This plan includes additional prescription drug (Part-D) coverage. The IIHCP Community Choice (HMO) has a monthly premium of $0 and has an in-network maximum out-of-pocket limit of $2,000 (MOOP). This means that if you get sick or need a high cost procedure the co-pays are capped once you pay $2,000 out-of-pocket. This can be a extremely nice safety net.
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IIHCP Community Choice (HMO) is a Local HMO. With a health maintenance organization (HMO) you will be required to receive most of your health care from an in-network provider. Health maintenance organizations require that you select a primary care physician (PCP). Your PCP will serve as your personal doctor to provide all of your basic healthcare services. If you require specialized care or a physician specialist, your primary care physician will make the arrangements and inform you where you can go in the network. You will need your PCPs okay, called a referral. Services received from an out-of-network provider are not typically covered.
Innovative Integrated Health Community Plans works with Medicare to provide significant coverage beyond Part A and Part B benefits. If you decide to sign up for IIHCP Community Choice (HMO) you still retain Original Medicare. But you will get additional Part A (Hospital Insurance) and Part B (Medical Insurance) coverage from Innovative Integrated Health Community Plans and not Original Medicare. With Medicare Advantage you are always covered for urgently needed and emergency care. Plus you receive all the benefits of Original Medicare from Innovative Integrated Health Community Plans except hospice care. Original Medicare still provides you with hospice care even if you sign up for Medicare Advantage.
2022 Innovative Integrated Health Community Plans Medicare Advantage Plan Costs
| Name: | IIHCP Community Choice (HMO) |
|---|---|
| Plan ID: | H0826-001 |
| Provider: | Innovative Integrated Health Community Plans |
| Year: | 2022 |
| Type: | Local HMO |
| Monthly Premium C+D: | $0 |
| Part C Premium: | $0.00 |
| MOOP: | $2,000 |
| Part D (Drug) Premium: | $0.00 |
| Part D Supplemental Premium | $0.00 |
| Total Part D Premium: | $0.00 |
| Drug Deductible: | $100.00 |
| Tiers with No Deductible: | 1 |
| Gap Coverage: | Yes |
| Benchmark: | not below the regional benchmark |
| Type of Medicare Health: | Enhanced Alternative |
| Drug Benefit Type: | Enhanced |
| Similar Plan: | H0826-001 |
| New Plan: | 2023 H0826-001 |
IIHCP Community Choice (HMO) Part-C Premium
Innovative Integrated Health Community Plans charges a $0.00 Part-C premium. The Part C premium covers Medicare medical, hospital benefits and supplemental benefits if offered. You generally are also responsible for paying the Part B premium.
H0826-001 Part-D Deductible and Premium
IIHCP Community Choice (HMO) has a monthly drug premium of $0.00 and a $100.00 drug deductible. This Innovative Integrated Health Community Plans plan offers a $0.00 Part-D Basic Premium that is not below the regional benchmark. This covers the basic prescription benefit only and does not cover enhanced drug benefits such as medical benefits or hospital benefits. The Part D Supplemental Premium is $0.00 this Premium covers any enhanced plan benefits offered by Innovative Integrated Health Community Plans above and beyond the standard PDP benefits. This can include additional coverage in the gap, lower co-payments and coverage of non-Part D drugs. The Part D Total Premium is $0.00 . The Part D Total Premium is the addition of the supplemental and basic premiums for some plans this amount can be lowered due to negative basic or supplemental premiums.
Innovative Integrated Health Community Plans Gap Coverage
In 2022 once you and your plan provider have spent $4430 on covered drugs. (combined amount plus your deductible) You will be in the coverage gap. (AKA "donut hole") You will be required to pay 25% for prescription drugs unless your plan offers additional coverage. This Innovative Integrated Health Community Plans plan does offer additional coverage through the gap.
H0826-001 Formulary or Drug Coverage
IIHCP Community Choice (HMO) formulary is divided into Tiers or levels of coverage based on usage and according to the medication costs. Each tier will have a defined copay that you must pay to receive the drug. Drugs in lower tiers will usually cost less than those in higher tiers. By reviewing different Medicare Drug formularies, you can pick a Medicare Advantage plan that covers your medications. Additionally, you can choose a plan that has your drugs listed at a lower price. You can see complete 2022 IIHCP Community Choice (HMO) H0826-001 Formulary here.
| Drug Tier | Copay Preferred Pharmacy |
Copay Nonpreferred Pharmacy |
|---|---|---|
| Tier 1 | NA | $0 |
| Tier 2 | NA | $10 |
| Tier 3 | NA | $47 |
| Tier 4 | NA | $100 |
| Tier 5 | NA | 31% |
Coverage Area for IIHCP Community Choice (HMO)
(Click county to compare all available Advantage plans)
| State: |
California |
|---|---|
| County: |
Fresno Kern Tulare |
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Source: CMS.
Data as of September 1, 2021.
Notes: Data are subject to change as contracts are finalized. For 2022, enhanced alternative may offer additional cost sharing reductions in the gap on a sub-set of the formulary drugs, beyond the standard Part-D benefit.
Includes 2022 approved contracts. Employer sponsored 800 series and plans under sanction are excluded.