Western Slope RMHP Medicare Benefit Comparison Highlights 2012
Contact an RMHP Medicare Specialist:
888-251-1330 (TTY: 711) to be connected with a licensed RMHP Medicare Sales Specialist
8:00 a.m. to 8:00 p.m., Mountain Time, 7 days a week
 |
| Enrollment Options By clicking on the Online Enrollment link, you will be leaving the RMHP website | Enroll
Enroll Online- Green Plan Green Plan+Rx | Enroll Enroll Online- Thrifty Plan Thrifty Plan+Rx | Enroll Enroll Online- Standard Plan Standard Plan+Rx | Enroll
Enroll Online- Plus Plan Plus Plan+Rx |
Monthly Plan Premium
Medical Only
Prescription Drug
Total
| $8.00*
$40.10 $48.10* * plus you must continue to pay Medicare Part B premium | $34.00*
$40.20 $74.20* * plus you must continue to pay Medicare Part B premium | $73.40*
$47.40 $120.80* * plus you must continue to pay Medicare Part B premium | $156.80*
$89.40 $246.20* * plus you must continue to pay Medicare Part B premium |
| | $500 per calendar year (annual deductible). Applies to all services except Preventive Care, Primary Care Physician and Specialist Care office visits, lab services, and Emergency room services. | $500 per calendar year (annual deductible). Applies to all services except Preventive Care, Primary Care Physician and Specialist Care office visits, lab services, and Emergency room services. | | |
Medical Out of Pocket Maximum | $6,700 per calendar year. Amounts you pay for RMHP deductibles, copayments and coinsurance for Medicare-covered services count toward the maximum out-of-pocket amount | | | |
Primary Care Physician
Office Visit Copayment | $15 per visit Deductible does not apply | $20 per visit Deductible does not apply | | |
Specialist Care Physician
Office Visit Copayment | $40 per visit Deductible does not apply | $50 per visit Deductible does not apply | | |
Inpatient Hospital Copayment | After the $500 annual deductible $250 copay per day up to 7 days per admission | After the $500 annual deductible $200 copay per day up to 5 days per admission | | |
| | After the $500 annual deductible $400 per visit | After the $500 annual deductible $400 per visit | | |
| | $150 per trip Deductible does not apply | $200 per trip Deductible does not apply | | |
| | $65 per visit Worldwide Deductible does not apply | $50 per visit
within the United States Deductible does not apply | | |
| | $40 per visit Worldwide Deductible does not apply | $50 per visit
within the United States Deductible does not apply | | |
| Additional Medicare Part D links | About RMHP Medicare Part D Part D Formulary | About RMHP Medicare Part D Part D Formulary | About RMHP Medicare Part D Part D Formulary | About RMHP Medicare Part D Part D Formulary |
Part D Prescription Drug Benefit | $125 Deductible- drugs on Tiers 3, 4 & 5 only | | | |
$2 copay Tier 1
$13 copay Tier 2
$45 copay Tier 3
$87 copay Tier 4
30% coinsurance Tier 5
|
$3 copay Tier 1
$12 copay Tier 2
$45 copay Tier 3
$90 copay Tier 4
33% coinsurance Tier 5
|
$10 copay Tiers 1 & 2
$40 copay Tier 3
$60 copay Tier 4
33% coinsurance Tier 5
|
$8.50 copay Tiers 1 & 2
$38 copay Tier 3
$58 copay Tier 4
33% coinsurance Tier 5
|
After $2,930 in retail drug expenses, Member pays up to 86% of the price for generic drugs and 50% of the price (plus the dispensing fee) for brand name drugs until the Member's out-of-pocket drug costs reach $4,700 After the Member's out-of-pocket drug costs reach $4,700, they pay
$2.60 copay generic;
$6.50 copay for all other drugs;
OR 5% (whichever is higher) | After $2,930 in retail drug expenses, Member pays up to 86% of the price for generic drugs and 50% of the price (plus the dispensing fee) for brand name drugs until the Member's out-of-pocket drug costs reach $4,700 After the Member's out-of-pocket drug costs reach $4,700, they pay
$2.60 copay generic;
$6.50 copay for all other drugs;
OR 5% (whichever is higher) | After $2,930 in retail drug expenses, Member pays up to 86% of the price for generic drugs and 50% of the price (plus the dispensing fee) for brand name drugs until the Member's out-of-pocket drug costs reach $4,700 After the Member's out-of-pocket drug costs reach $4,700, they pay
$2.60 copay generic;
$6.50 copay for all other drugs;
OR 5% (whichever is higher) |
After $2,930 in retail drug expenses, Members pay either an $8.50 copayment (for a one month supply) or up to 86% of the price for generic drugs whichever is lower, and 50% of the price (plus the dispensing fee) for brand name drugs until the Member's out-of-pocket drug costs reach $4,700. After the Member's out-of-pocket drug costs reach $4,700, they pay $2.60 copay generic; $6.50 copay for all other drugs; OR 5% (whichever is higher) |
| Mail Order Rx | 3 copays for 3 month supply | 2.5 copays for 3 month supply | 2.5 copays for 3 month supply | 2.5 copays for 3 month supply |
Annual Routine Physical Exam | $0 Deductible does not apply | $0 Deductible does not apply | | |
Preventive Screening Services | $0 Deductible does not apply | $0 Deductible does not apply | | |
| | After the $500 annual deductible $0 days 1-20 $100 days 21-100 | After the $500 annual deductible $0 days 1-20 $100 days 21-100 | $0 days 1-20 $95 days 21-100 | $0 days 1-20 $95 days 21-100 |
Durable Medical Equipment | After the $500 annual deductible 20% coinsurance | After the $500 annual deductible 20% coinsurance | | |
 |
You may be able to get Extra Help to pay for your prescription drug premiums and costs. To see if you qualify for extra help, call:
- 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048. 24 hours a day/7 days a week:
- The Social Security Office at 1-800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday. TTY users should call 1-800-325-0778; or
- Your State Medicaid Office
RMHP Medical Only plans are open for enrollment at any time. Medicare beneficiaries may enroll in Rocky Mountain Medicare plans through the CMS Medicare Online Enrollment Center located at http://www.medicare.gov. The benefit information provided herein is a brief summary, not a comprehensive description of benefits. For more information contact the plan. People with End Stage Renal Disease (kidney failure) may enroll in certain circumstances. Benefits, formulary, pharmacy network, premiums, copays, and coinsurance may change on January 1, 2013. Limitations, copayments, and restrictions may apply.
RMHP Medicare Optional Plans - Dental Plan (for a low, additional premium)
- Vision Plan (for a low, additional premium)
RMHP Medicare Extras - Silver&Fit Affinity walking program to support wellness (included)
- Vision discount program (included)
- Hearing discount program (included)
- Discounts on complementary care, for example: chiropractic and massage therapy (included)
Get detailed information on Medicare Optional Plans & Extras
2012 RMHP Medicare Plan Information
For a detailed 2012
Summary of Benefits for plans with Part D Prescription Drug coverage, click on the link. For a detailed 2012
Summary of Benefits for the Medical-only plans, click on the link.
For the 2012 Evidence of Coverage, click on the link. This document provides more detailed information about:
The 2012 Evidence of Coverage provides more detailed information about:
- Conditions associated with receipt or use of benefits, limitations, and exclusions
- Out-of-network coverage
- Grievance, coverage determinations, appeals procedures and exceptions process (For plans with Part D Prescription Drug coverage, see Chapter 9 of the EOC. For medical-only plans, see Chapter 7 of the EOC.)
- Quality assurance policies and procedures, including medication therapy management, and drug and/or utilization management
- Potential for contract termination
- Beneficiaries' and plan's rights and responsibilities upon disenrollment
2011 RMHP Medicare Plan Information
For a detailed 2011 Summary of Benefits for plans with Part D Prescription Drug coverage click on the link. For a detailed 2011 Summary of Benefits for medical-only plans, click on the link.
For the 2011 Evidence of Coverage, click on the link.
Counties in the Western Slope Service Area: Alamosa, Archuletta, Chaffee, Conejos, Costilla, Delta, Dolores, Eagle, Garfield, Grand, Gunnison, Jackson, Hinsdale, La Plata, Lake, Mineral, Mesa, Montezuma, Moffat, Ouray, Montrose, Rio Blanco, Pitkin, Routt, Rio Grande, San Juan, Saguache, Summit, San Miguel
To see a summary of the RMHP grievance, coverage determination (including Medicare Part D exceptions), and appeals processes, click here.
RMHP's contract with Medicare is renewed annually. The availability of coverage beyond the end of the current contract year is not guaranteed. RMHP has contracted with Medicare to provide benefits since 1977.
This page was last updated: 03/07/12. Please call to confirm you have the most up to date information about our Medicare Plans. Full list of Medicare Disclaimers.
Medicare-approved Cost plan. H0602_1037024 MC150WEB Pending Approval
