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Special Needs Plans are either HMO or PPO plans that limit membership to people
with special needs as defined by the health plan. See Page 2 for specific plan
requirements.
Chronic care HMOs have a network of doctors, hospitals, and other health care providers who have
contracted with the plan to provide care to Medicare beneficiaries in that plan. In an HMO, you
must generally get your medical care and services from providers and hospitals in the plan’s
network (except emergency or urgent care). You generally must see a primary care doctor before
getting care from a specialist. If you get health care outside the plan’s network, you may
have to pay the full cost of care for that visit.
In addition, special needs plans (SNP) are often designed to provide special care management
and services including care focused management based on the identified disease or setting.
The attached comparison sheets should be used as a guideline in selecting the type of
health plan that meets your individual needs.
BENEFITS ASSISTANCE PROGRAMA State Health Insurance Assistance Program (SHIP)
A program of the Area Agency on Aging, Region One
1366 East Thomas, Suite 108, Phoenix, AZ 85014
602-280-1059
This project was supported in part by grant number 15AAAZMSHI, from the U.S. Administration for
Community Living, Department of Health and Human Services, Washington, D.C. 20201. Grantees
undertaking projects under government sponsorship are encouraged to express freely their findings and
conclusions. Points of view or opinions do not, therefore, necessarily represent official Administration
for Community Living policy.
2019Medicare Advantage
Chronic Conditions & Institutional CareSpecial Needs Plans (SNP)
Maricopa County
Most current revision 10/16/2018
See plan page to determine the specific "Special Need" required to select this plan.
Chronic Condition Plans - Income not an issue Page
Allwell CHF/Diabetes Medicare (HMO SNP) 3CIGNA-HealthSpring Achieve Plus (HMO SNP) 5Fresenius Total Health (PPO SNP)
Resides in Long-Term Care FaciityAmerivantage Caremore Care to You (HMO SNP) 7United Healthcare Nursing Home Plan (PPO SNP) 9
Special Needs Plans SNPs
Allwell CHF/Diabetes Medicare (HMO SNP) Page 3
Plan Number H0351-038 800-333-3930
STAR Rating 4.0 out of 5 www.allwellmedicare.com
Must have diabetes or chronic heart failure to enroll into this plan
Monthy Premium $0
Maximum-out-of-Pocket Limit (MOOP) $3,400
Out-of-Network Services not covered
Physician/Provider Services Copayments
Primary Care $0
Specialist $15
Mental Health $25
PT, OT, Speech Therapy $35
Chiropractic (limited services) $0, Optional plan available
Podiatry (limited visits) $0 - $25
Hospital (Inpatient) Care - Copayments
Hospital inpatient Per Days 1 - 10 $205
Hospital inpatient Per Days 11 - beyond $0
Skilled Nursing Facility (SNF) Per Days 1 - 20 $0
Skilled Nursing Facility (SNF) Per Days 21 - 100 $170
Oupatient Care - Copayments
Hospital Surgery Center $200
Ambulatory Surgery Center
Emergency/Urgent Care Services - Copayments
Emergency Room $120
Urgent Care $15
Ambulance per Trip $350
Diagnostic Testing
Radiology Tests and Imaging $0 - $200
Lab Tests $0 - $25
Durable Medical Equipment (DME)
Diabetes Supplies $0
Equipment 20%
Prosthetic Device 20%
Prescription Drugs
Part D drugs - Deductible $0
Call Plan or consult Medicare.gov Plan Finder to determine your estimated drug cost
Part B Immunizations - Flu, pheumonia, and hepititis B vacinnations 0%
Transplant drug and facility based infusions such as chemotherapy 20%
Allwell CHF/Diabetes Medicare (HMO SNP) Page 4
Physician Network, Additional Benefits, Preferred Pharmacies and Hospital Networks
Physician Network
To determine if your physician is in this specific plan, check with the plan and/or call your physician.
Additional Benefits
Vision (Exams, lenses & glasses) Optional plan available
Hearing (Routine) Exams Not Covered
Hearing Aid Appliance Not Covered
Home Health Care Not Covered
Transportation $0, Up to (10) 1 way trips
Dental Optional plan available
Over-the-Counter allowance $75 / quarter
24 hour Nurse Line $0
Gym Membership $0
Meals after Hosital Stay Up to 28 meals @ $0 copay
Preferred pharmacies:
If your plan has preferred pharmacies, using those pharmacies may save you money.
Albertsons Costco CVS
Frys Safeway Walmart
Hospital Networks
Abrazo St Lukes Banner
West Campus (Goodyear) Tempe Baywood
Central Campus Phoenix Boswell
Maryvale Del Webb
Phoenix (PV-Bell) Maricopa Medical Center Desert
Arrowhead Estrella
Gateway
Honor Health Goldfield (Apache Junction)
Scottsdale Healthcare Osborn University Medical Center
Scottsdale Healthcare Shea Ironwood
Scottsdale Heallthcare Thompson Peak Thunderbird
John C Lincoln Deer Valley
John C Lincoln Phoenix
CIGNA-HealthSpring Achieve Plus (HMO SNP) Page 5
Plan Number H0354-027 855-561-3811
STAR Rating 4.5 out of 5 www.cignahealthspring.com
Must have diabetes to enroll into this plan
Monthy Premium $0
Maximum-out-of-Pocket Limit (MOOP) $3,800
Out-of-Network Services not covered
Physician/Provider Services Copayments
Primary Care $0
Specialist $25
Mental Health $25
PT, OT, Speech Therapy $25
Chiropractic (limited services) $15
Podiatrist $0
Hospital (Inpatient) Care - Copayments
Hospital inpatient Per Days 1 - 7 $200
Hospital inpatient Per Days 8 - beyond $0
Skilled Nursing Facility (SNF) Per Days 1 - 20 $0
Skilled Nursing Facility (SNF) Per Days 21 - 100 $172
Oupatient Care - Copayments
Hospital Surgery Center $325
Ambulatory Surgery Center $125
Emergency/Urgent Care Services - Copayments
Emergency Room $90
Urgent Care $0
Ambulance per Trip $200
Diagnostic Testing
Radiology Tests and Imaging $0 - $150 or 20%
Lab Tests $0
Durable Medical Equipment (DME)
Diabetes Supplies $0
Equipment 20%
Prosthetic Device 20%
Prescription Drugs
Part D drugs - Deductible (Tier 5) $200
Call Plan or consult Medicare.gov Plan Finder to determine your estimated drug cost
Part B Immunizations - Flu, pheumonia, and hepititis B vacinnations $0
Transplant drug and facility based infusions such as chemotherapy 20%
CIGNA-HealthSpring Achiecve Plus (HMO SNP) Page 6Physician Network, Additional Benefits, Preferred Pharmacies and Hospital Networks
Physician Network
To determine if your physician is in this specific plan, check with the plan and/or call your physician.
Additional Benefits
Vision (Exams, lenses & glasses) $25; $0 - $100 annual allowance
Hearing (Medicare Covered & Routine) Exams $10
Hearing Aid Appliance Not Covered
Home Health Care $0
Transportation $0 Unlimited
Dental Separate Plan Available
Over-the-Counter allowance Not Covered
24 hour Nurse Line $0
Gym Membership $0
Preferred pharmacies:
If your plan has preferred pharmacies, using those pharmacies may save you money.
Osco Cigna Center Pharmacy Fry's
Walmart Safeway Walgreens
Hospital Networks
Abrazo Dignity Health BannerWest Campus (Goodyear) Arizona General Baywood
Central Campus Chandler Regional Boswell
Maryvale Mercy Gilbert Del Webb
Phoenix (PV-Bell) St Joseph’s Desert
Arrowhead St Joseph’s Westgate Estrella
Gateway
Honor Health St Luke’s Goldfield (Apache Junction)
Scottsdale Healthcare Osborn Tempe University Medical Center
Scottsdale Healthcare Shea Phoenix Ironwood
Scottsdale Heallthcare Thompson Peak Thunderbird
John C Lincoln Deer Valley Maricopa Medical Center
John C Lincoln Phoenix
Amerivantage CareMore Care to You (HMO SNP) Page 7
Plan Number 2593-019-0 877 211-6614
STAR Rating 4.0 out of 5 NOTE: Dialysis co-pay is $0 www.amerigroup.com/medicare
Must live in an assisted living facility
Monthy Premium $0
Maximum-out-of-Pocket Limit (MOOP) $3,000
Out-of-Network Services Not Covered
Physician/Provider Services Copayments
Primary Care $0
Specialist $0
Mental Health $0
PT, OT, Speech Therapy $0
Chiropractic (limited services) $0
Podiatrist $0 / 4 visits yr
Hospital (Inpatient) Care - Copayments
Hospital inpatient Per Days 1 - 5 $175
Hospital inpatient Per Days 6 - 255 $0
Skilled Nursing Facility (SNF) Per Days 1 - 20 $0
Skilled Nursing Facility (SNF) Per Days 21 - 100 $0
Oupatient Care - Copayments
Hospital Surgery Center $175
Ambulatory Surgery Center $100
Emergency/Urgent Care Services - Copayments
Emergency Room $100
Urgent Care $0
Ambulance per Trip $195
Diagnostic Testing
Radiology Tests and Imaging $0 - $150, 20%
Lab Tests $0
Durable Medical Equipment (DME)
Diabetes Supplies $0
Equipment 0% - 20%
Prosthetic Device 0% - 20%
Prescription Drugs
Part D drugs - Deductible $0
Call Plan or consult Medicare.gov Plan Finder to determine your estimated drug cost
Part B Immunizations - Flu, pheumonia, and hepititis B vacinnations $0
Transplant drug and facility based infusions such as chemotherapy 20%
Amerivantage CareMore Care to You (HMOfSNP) Page 8
Physician Network, Additional Benefits, Preferred Pharmacies and Hospital Networks
Physician Network
To determine if your physician is in this specific plan, check with the plan and/or call your physician.
Additional Benefits
Vision (Exams, lenses & glasses) $0, $100 (every 2 years)
Hearing (Routine) Exams $0
Hearing Aid Appliance $0, $1500
Home Health Care $0
Transportation $0 (6) one-way trips
Dental Preventive only
Over-the-Counter allowance $50 per quarter
24 hour Nurse Line $0
Gym Membership $0
Preferred pharmacies:
If your plan has preferred pharmacies, using those pharmacies may save you money.
The pharmacy network for this plan is NOT restricted.
Hospital Networks
Abrazo St Luke’sWest Campus (Goodyear) Tempe
Central Campus Phoenix
Maryvale
Phoenix (PV-Bell)
Arrowhead
UnitedHealthcare Nursing Home Plan (PPO SNP) Page 9
Plan Number 0710-005 888-834-3721
STAR Rating 4.0 out of 5 Renal Dialysis $0 / 20% www.uhcmedicaresolutions.com
Must live in a nursing home available through the plan
Monthy Premium $32.60
Maximum-out-of-Pocket Limit (MOOP) In- / Out-of-Network $1,500 / $5,100
Physician/Provider Services Copayments
Primary Care $0 / 30%
Specialist $0 / 30%
Mental Health $0-20% / 30%
PT, OT, Speech Therapy $0-20% / 30%
Chiropractic (limited services) $0 - 20% / 30%
Podiatry $0 - 20% / 30%
Hospital (Inpatient) Care - Copayments
Hospital inpatient Days 1 - 90 $1,300 / $1,300
Skilled Nursing Facility (SNF) Days 1 - 100 $0 / 30%
Oupatient Care - Copayments
Hospital Surgery Center $0 / 30%
Ambulatory Surgery Center $0 / 30%
Emergency/Urgent Care Services - Copayments
Emergency Room $0
Urgent Care $65
Ambulance per Trip 20%
Diagnostic Testing
Radiology Tests and Imaging $0-20% / 30%
Lab Tests $0 / $0
Durable Medical Equipment (DME)
Diabetes Supplies 20% / 30%
Equipment 20% / 30%
Prosthetic Device $0 - 20% / 30%
Prescription Drugs
Part D drugs - Deductible $415
Call Plan or consult Medicare.gov Plan Finder to determine your estimated drug cost
Part B Immunizations - Flu, pheumonia, and hepititis B vacinnations $0 / $0
Transplant drug and facility based infusions such as chemotherapy 20% / 30%
In-Network charges noted below reflect services performed in the Nursing Home.
UnitedHealthcare Nursing Home Plan (PPO SNP) Page 10
Physician Network, Additional Benefits, Preferred Pharmacies and Hospital Networks
Physician Network
To determine if your physician is in this specific plan, check with the plan and/or call your physician.
Additional Benefits
Vision (Exams, lenses & glasses) $0 / 30, $300
Hearing (Medicare Covered & Routine) Exams $0-20% / 30%
Hearing Aid Appliance $0 / $0
Home Health Care Not Covered
Transportation $0 (60) 1-way trips / 75%
Dental $0, $5000 / $0, $5000
Over-the-Counter allowance $365 per quarter
24 hour Nurse Line Not Covered
Gym Membership Not Covered
Preferred pharmacies:
If your plan has preferred pharmacies, using those pharmacies may save you money.
The pharmacy network for this plan is NOT restricted.
Or list pharmacies
Hospital Networks delete hospitals not in network
Abrazo Dignity Health BannerWest Campus (Goodyear) Arizona General Baywood
Central Campus Chandler Regional Boswell
Maryvale Mercy Gilbert Del Webb
Phoenix (PV-Bell) St Joseph’s Desert
Arrowhead St Joseph’s Westgate Estrella
Gateway
Honor Health St Luke’s Goldfield (Apache Junction)
Scottsdale Healthcare Osborn Tempe University Medical Center
Scottsdale Healthcare Shea Phoenix Ironwood
Scottsdale Heallthcare Thompson Peak Thunderbird
John C Lincoln Deer Valley
John C Lincoln Phoenix