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VillageHealth (HMO-POS C-SNP) By VillageHealth



VillageHealth (HMO-POS C-SNP) H5943 002 0 is a 2023 Medicare Advantage Special Needs Plan plan by VillageHealth. This plan from VillageHealth works with Medicare to give you significant coverage beyond original Medicare. If you decide to sign up you still retain Original Medicare. But you will get additional Part A (Hospital Insurance) and Part B (Medical Insurance) coverage from VillageHealth and not Original Medicare. All Medicare SNPs also provide Medicare additional Part-D drug coverage. VillageHealth (HMO-POS C-SNP) H5943-002 is a Chronic Condition SNP (C-SNP). A Chronic Condition SNP is for beneficiaries with the following severe or disabling chronic conditions: Chronic Lung Disorders. If you have Medicare and you develop certain severe or disabling conditions you can join a Medicare SNP designed to serve people with those conditions at any time.







2023 Medicare Special Needs Plan Details

Plan Name:VillageHealth (HMO-POS C-SNP)
Plan ID:H5943 002 0
Special Needs Type:Chronic or Disabling Condition
Provider:VillageHealth
Plan Year:2023
Plan Type:Local HMO
Monthly Premium C+D:$31.20
Chronic Condition:Chronic Lung Disorders
Part C Premium:
Part D (Drug) Premium:
Part D Supplemental Premium
Total Part D Premium:
Drug Deductible:
Tiers with No Deductible:0
Benchmark:not below the regional benchmark
Type of Medicare Health Plan:
Drug Benefit Type:Enhanced
Gap Coverage:No
Similar Plan: H5943-001


The VillageHealth (HMO-POS C-SNP) H5943-002 is available to residents to Medicare eligible seniors in California. All Medicare SNPs must provide Medicare additional prescription drug (Part-D) coverage. VillageHealth (HMO-POS C-SNP) 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 need special care for a physician specialist, your primary care physician will make the arrangements and tell you where you can go in the network. You will need your PCPs okay, called a referral. Without getting a referral or services received from out-of-network providers are not typically covered by the plan.



How much does VillageHealth (HMO-POS C-SNP) cost?


Part-C Premium

A monthly premium is the fee you pay to the plan in exchange for coverage. VillageHealth charges a 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.


Part-D Deductible and Premium

An annual deductible is the amount you pay out-of-pocket for your prescription drugs before your plan begins to pay. VillageHealth (HMO-POS C-SNP) has a monthly drug premium of and a drug deductible. This VillageHealth plan offers a 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 . This Premium covers any enhanced plan benefits offered by VillageHealth 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 . The Part D Total Premium is the addition of supplemental and basic premiums for some plans this amount can be lowered due to negative basic or supplemental premiums.


VillageHealth Gap Coverage

In 2023 once you and your plan provider have spent $4660 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 VillageHealth plan does not offer additional coverage through the gap.


H5943-002 Formulary and Drug Coverage

VillageHealth (HMO-POS C-SNP) 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 Special Needs Plan that covers your medications. Additionally, you can choose a plan that has your drugs listed at a lower price.

Drug Tier Copay
Preferred
Pharmacy		 Copay
Nonpreferred
Pharmacy
Tier 1 $0 $3
Tier 2 25% 25%
Tier 3 25% 25%
Tier 4 25% 25%
Tier 5 25% 25%
The complete VillageHealth (HMO-POS C-SNP) H5943-002 Formulary
*Initial Coverage Phase and 30 day supply





2023 Summary of Benefits

The benefit information provided is a summary of what VillageHealth (HMO-POS C-SNP) covers and what you pay (such as copayments and coinsurance amounts) for certain common medical events. The Summary of Benefits from VillageHealth 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.

Wellness programs (e.g., fitness, nursing hotline)Covered


Contact lenses


In-Network Vision$0 copay


Eyeglass frames


In-Network Vision$0 copay


Eyeglass lenses


In-Network Vision$0 copay


Eyeglasses (frames and lenses)


In-Network Vision$0 copay


Other


VisionNot covered


Routine eye exam


In-Network Vision$0 copay


Upgrades


VisionNot covered



In-Network Transportation$0 copay
In-Network Skilled Nursing FacilityIn 2023 the amounts for each benefit period are:
$0 copay for days 1 through 20
$200 copay per day for days 21 through 100
Out-of-Network Skilled Nursing FacilityNot Applicable


Occupational therapy visit


Out-of-Network Rehabilitation services20% coinsurance
In-Network Rehabilitation services20% coinsurance


Physical therapy and speech and language therapy visit


In-Network Rehabilitation services20% coinsurance
Out-of-Network Rehabilitation services20% coinsurance


Cleaning


In-Network Preventive dental$0 copay


Dental x-ray(s)


In-Network Preventive dental$0 copay


Fluoride treatment


In-Network Preventive dental$0 copay


Oral exam


In-Network Preventive dental$0 copay



Out-of-Network Preventive care$0 copay
In-Network Preventive care$0 copay
In-Network Outpatient hospital coverage20% coinsurance per visit
Out-of-Network Outpatient hospital coverage20% coinsurance per visit
In-Network Other health plan deductibles?No
Optional supplemental benefitsNo


Inpatient hospital - psychiatric


In-Network Mental health servicesIn 2023 the amounts for each benefit period are:
$1,600 deductible for days 1 through 60
$400 copay per day for days 61 through 90
Out-of-Network Mental health servicesIn 2023 the amounts for each benefit period are:
$1,600 deductible for days 1 through 60
$400 copay per day for days 61 through 90


Outpatient group therapy visit


In-Network Mental health services$0 copay
Out-of-Network Mental health services$0 copay


Outpatient group therapy visit with a psychiatrist


In-Network Mental health services$0 copay
Out-of-Network Mental health services$0 copay


Outpatient individual therapy visit


Out-of-Network Mental health services$0 copay
In-Network Mental health services$0 copay


Outpatient individual therapy visit with a psychiatrist


Out-of-Network Mental health services$0 copay
In-Network Mental health services$0 copay


Chemotherapy


In-Network Medicare Part B drugs0-20% coinsurance
Out-of-Network Medicare Part B drugs0-20% coinsurance


Other Part B drugs


In-Network Medicare Part B drugs0-20% coinsurance
Out-of-Network Medicare Part B drugs0-20% coinsurance


Diabetes supplies


In-Network Medical equipment/supplies$0 copay
Out-of-Network Medical equipment/supplies$0 copay


Durable medical equipment (e.g., wheelchairs, oxygen)


In-Network Medical equipment/supplies0-20% coinsurance per item
Out-of-Network Medical equipment/supplies0-20% coinsurance per item


Prosthetics (e.g., braces, artificial limbs)


Out-of-Network Medical equipment/supplies0-20% coinsurance per item
In-Network Medical equipment/supplies0-20% coinsurance per item



Maximum out-of-pocket enrollee responsibility (does not include prescription drugs)$8,300 In and Out-of-network
$8,300 In-network
Out-of-Network Inpatient hospital coverageIn 2023 the amounts for each benefit period are:
$1,600 deductible for days 1 through 60
$400 copay per day for days 61 through 90
In-Network Inpatient hospital coverageIn 2023 the amounts for each benefit period are:
$1,600 deductible for days 1 through 60
$400 copay per day for days 61 through 90


Fitting/evaluation


HearingNot covered


Hearing aids - inner ear


HearingNot covered


Hearing aids - outer ear


HearingNot covered


Hearing aids - over the ear


HearingNot covered


Hearing exam


In-Network Hearing20% coinsurance
Out-of-Network Hearing20% coinsurance



Health plan deductible$226 per year for some in-network and out-of-network services.
In-Network Ground ambulance20% coinsurance
Out-of-Network Ground ambulance20% coinsurance


Foot exams and treatment


In-Network Foot care (podiatry services)20% coinsurance
Out-of-Network Foot care (podiatry services)20% coinsurance


Routine foot care


In-Network Foot care (podiatry services)$0 copay


Emergency


Emergency care/Urgent care20% coinsurance per visit (always covered)


Urgent care


Emergency care/Urgent care$0 copay


Primary


In-Network Doctor visits$0 copay
Out-of-Network Doctor visits20% coinsurance per visit


Specialist


Out-of-Network Doctor visits0-20% coinsurance per visit
In-Network Doctor visits0-20% coinsurance per visit


Diagnostic radiology services (e.g., MRI)


In-Network Diagnostic procedures/lab services/imaging20% coinsurance
Out-of-Network Diagnostic procedures/lab services/imaging20% coinsurance


Diagnostic tests and procedures


Out-of-Network Diagnostic procedures/lab services/imaging20% coinsurance
In-Network Diagnostic procedures/lab services/imaging20% coinsurance


Lab services


In-Network Diagnostic procedures/lab services/imaging$0 copay
Out-of-Network Diagnostic procedures/lab services/imaging$0 copay


Outpatient x-rays


In-Network Diagnostic procedures/lab services/imaging20% coinsurance
Out-of-Network Diagnostic procedures/lab services/imaging20% coinsurance


Diagnostic services


In-Network Comprehensive dental$0 copay


Endodontics


In-Network Comprehensive dental$0-395 copay


Extractions


In-Network Comprehensive dental$0 copay


Non-routine services


In-Network Comprehensive dental$0-125 copay


Periodontics


In-Network Comprehensive dental$0-250 copay


Prosthodontics, other oral/maxillofacial surgery, other services


In-Network Comprehensive dental$0-350 copay


Restorative services


In-Network Comprehensive dental$0-350 copay



In-Network Additional benefits and/or reduced cost-sharing for enrollees with certain health conditions?No




CMS Star Ratings


Is VillageHealth (HMO-POS C-SNP) a good plan? VillageHealth (HMO-POS C-SNP) received 3.5 overall star rating from the CMS. The CMS uses a Star Rating System to measure how well Medicare Special Needs Plans perform. Plans are rated on a one-to-five scale, with one star representing poor performance and five stars representing excellent performance. Medicare Advantage with prescription drug (Part D) coverage (MA-PD) contracts are rated on up to 38 unique quality and performance measures. You can use the CMS star rating to compare VillageHealth (HMO-POS C-SNP) performance among several different plans.

2022 Overall Rating
Part C Summary Rating
Part-D Summary 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


Staying Healthy, Screening, Testing, & Vaccines

Total Preventative Rating
Breast Cancer Screening
Colorectal Cancer Screening
Annual Flu Vaccine
Monitoring Physical Activity


Managing Chronic And Long Term Care for Older Adults

Total Rating
SNP Care Management
Medication Review
Pain Assessment
Osteoporosis Management
Diabetes Care - Eye Exam
Diabetes Care - Kidney Disease
Diabetes Care - Blood Sugar
Controlling Blood Pressure
Reducing Risk of Falling
Improving Bladder Control
Medication Reconciliation
Statin Therapy


Member Experience with H5943-002 Health Plan

Total Experience Rating
Getting Needed Care
Getting Appointments
Customer Service
Health Care Quality
Rating of Health Plan
Care Coordination


Member Complaints and Changes in Plans Performance

Total Rating
Complaints about Health Plan
Members Leaving the Plan
Health Plan Quality Improvement


Health Plan Customer Service Rating for VillageHealth

Total Customer Service Rating
Timely Decisions About Appeals
Reviewing Appeals Decisions
Call Center, TTY, Foreign Language


Drug Plan Customer Service Ratings

Total Rating
Call Center, TTY, Foreign Language


Ratings For Member Complaints and Changes in the Drug Plans Performance

Total Rating
Complaints about the Drug Plan
Members Choosing to Leave the Plan
Drug Plan Quality Improvement


Member Experience with the Drug Plan

Total Rating
Rating of Drug Plan
Getting Needed Prescription Drugs


Drug Safety and Accuracy of Drug Pricing

Total Rating
MPF Price Accuracy
Drug Adherence for Diabetes Medications
Drug Adherence for Hypertension (RAS antagonists)
Drug Adherence for Cholesterol (Statins)
MTM Program Completion Rate for CMR
Statin with Diabetes


Coverage Area

(Click county or state to compare all available Advantage plans)

The availability of Medicare Special Need 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 VillageHealth (HMO-POS C-SNP) requires you to live in that plan’s service area. The service area is listed below:

State: Medicare California
County:SNP in Los Angeles





Source: CMS.

Plans as of Oct 1, 2022.

Last updated on

Notes: Data are subject to change. All contracts for 2023 have not been finalized. For 2023, enhanced alternative plans may offer additional cost sharing reductions in the gap on a sub-set of the formulary drugs, beyond the standard Part Part D benefit.

Includes 2023 approved contracts/plans. Employer sponsored 800 series plans and plans under sanction are excluded.

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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.