Medical Associates SmartPlan (Cost) H1651-001 is a 2023 Medicare Advantage Plan or Part-C by Medical Associates Health Plan, Inc. available to residents in Iowa. This plan does not provide extra prescription drug (Part-D) coverage. Medical Associates Health Plan, Inc. Medical Associates SmartPlan (Cost) has a monthly premium of $125.00 and has an in-network maximum out-of-pocket limit of $- (MOOP). This means that if you get sick or need a high-cost procedure the co-pays are capped once you pay
$- out-of-pocket. This can be an extremely nice safety net.
Medical Associates Health Plan, Inc. works with Medicare to provide significant coverage beyond Part A and Part B benefits. If you decide to sign up for Medical Associates SmartPlan (Cost) you still retain Original Medicare. But you will get extra Part A (Hospital Insurance)
and Part B (Medical Insurance) coverage from Medical Associates Health Plan, Inc. and not Original Medicare. With 2023 Medicare Advantage Plan you are always covered for urgently needed and emergency care. Plus, you receive all
the benefits of Original Medicare from Medical Associates Health Plan, Inc. except hospice care. Original Medicare still provides you with hospice care if you sign up for
Medicare Advantage in Iowa.
What type of plan is Medical Associates SmartPlan (Cost)
Medical Associates SmartPlan (Cost) is a Cost * plan. A Cost plan is operated by a Health Maintenance Organization (HMO) in accordance with a cost reimbursement contract. A Medicare Cost Plan is a type of HMO. These plans may work in much the same way, and have some of the same rules, as Medicare Advantage Plans. You may use the cost plans network of providers or receive their health care services through Original Medicare. With a Cost Plan, if you go to a non-network provider, the services are covered under Original Medicare. You would pay the Medicare Part A and Part B coinsurance and deductibles.
How much does Medical Associates SmartPlan (Cost) cost?
Part-C Premium
A monthly premium is the fee you pay to the plan in exchange for coverage. Medical Associates Health Plan, Inc. charges a $125.00 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.
2023 Summary of Benefits
The benefit information provided is a summary of what Medical Associates SmartPlan (Cost) covers and what you pay (such as copayments and coinsurance amounts) for certain common medical events. The Summary of Benefits from Medical Associates Health Plan, Inc. helps
get an idea of how much financial protection the plan is generally expected to provide for common health conditions. This section also contains information on coverage for in-network and out-of-network providers.
Physical therapy and speech and language therapy visit
Rehabilitation services
$0 copay
Cleaning
Preventive dental
Not covered
Dental x-ray(s)
Preventive dental
Not covered
Fluoride treatment
Preventive dental
Not covered
Oral exam
Preventive dental
Not covered
Preventive care
$0 copay
Outpatient hospital coverage
$0 copay
In-Network Other health plan deductibles?
Yes
Optional supplemental benefits
No
Inpatient hospital - psychiatric
Mental health services
$0 copay
Outpatient group therapy visit
Mental health services
$0 copay
Outpatient group therapy visit with a psychiatrist
Mental health services
$0 copay
Outpatient individual therapy visit
Mental health services
$0 copay
Outpatient individual therapy visit with a psychiatrist
Mental health services
$0 copay
Diabetes supplies
Medical equipment/supplies
$0 copay
Durable medical equipment (e.g., wheelchairs, oxygen)
Medical equipment/supplies
$0 copay
Prosthetics (e.g., braces, artificial limbs)
Medical equipment/supplies
$0 copay
Maximum out-of-pocket enrollee responsibility (does not include prescription drugs)
Not Applicable
Inpatient hospital coverage
$0 copay
Fitting/evaluation
Hearing
Not covered
Hearing aids - inner ear
Hearing
Not covered
Hearing aids - outer ear
Hearing
Not covered
Hearing aids - over the ear
Hearing
Not covered
Hearing exam
Hearing
$0 copay
Health plan deductible
$0
Ground ambulance
$0 copay
Foot exams and treatment
Foot care (podiatry services)
$0 copay
Routine foot care
Foot care (podiatry services)
$0 copay
Emergency
Emergency care/Urgent care
$0 copay
Urgent care
Emergency care/Urgent care
$0 copay
Primary
Doctor visits
$0 copay
Specialist
Doctor visits
$0 copay
Diagnostic radiology services (e.g., MRI)
Diagnostic procedures/lab services/imaging
$0 copay
Diagnostic tests and procedures
Diagnostic procedures/lab services/imaging
$0 copay
Lab services
Diagnostic procedures/lab services/imaging
$0 copay
Outpatient x-rays
Diagnostic procedures/lab services/imaging
$0 copay
Diagnostic services
Comprehensive dental
Not covered
Endodontics
Comprehensive dental
Not covered
Extractions
Comprehensive dental
Not covered
Non-routine services
Comprehensive dental
Not covered
Periodontics
Comprehensive dental
Not covered
Prosthodontics, other oral/maxillofacial surgery, other services
Comprehensive dental
Not covered
Restorative services
Comprehensive dental
Not covered
In-Network Additional benefits and/or reduced cost-sharing for enrollees with certain health conditions?
No
Coverage Area
(Click county or state to compare all available Advantage plans)
The availability of Medicare Advantage Plans will vary according to your region. This is why the Coverage Area matters in terms of Medicare eligibility. You will always be eligible for Original Medicare, but eligibility for Medical Associates SmartPlan (Cost) requires you to live in that plan’s service area. The service area is listed below:
How much does Medical Associates SmartPlan (Cost) cost?
Medical Associates Health Plan, Inc. charges a $125.00 monthly premium. A monthly premium is the fee you pay to the plan in exchange for coverage. The premium covers Medicare medical, hospital benefits and supplemental benefits if offered. You generally are also responsible for paying the Part B premium.
How much is Medical Associates SmartPlan (Cost) MOOP?
The maximum out-of-pocket (MOOP) is a yearly limit on your out-of-pocket costs. Medical Associates SmartPlan (Cost) by Medical Associates Health Plan, Inc. MOOP is $-. Once you spend $- you will pay nothing for Part A or Part B covered services.
What type of plan is Medical Associates SmartPlan (Cost)?
Medical Associates SmartPlan (Cost) is a Cost * plan. A Cost plan is operated by a (HMO) in accordance with a cost reimbursement contract. You may use the cost plans network of providers or receive their health care services through Original Medicare.
Notes: Data are subject to change as contracts are finalized. For 2023, enhanced alternative may offer extra cost sharing reductions in the gap on a sub-set of the formulary drugs, beyond the standard Part-D benefit.
Includes 2023 approved contracts. Employer sponsored 800 series and plans under sanction are excluded.
Site Search:
MedicareHelp.org is a privately-owned Non-governmental agency. The government website can be found at HealthCare.gov.
Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options. Enrollment depends on the plan’s contract renewal.
Every year, Medicare evaluates plans based on a 5-star rating system.
