|Part D Benefit:||Yes|
|Rx Gap Coverage:||Y|
FirstMedicare Direct HMO Standard is a Health Maintenance Organization (HMO) Medicare Advantage plan, by FirstMedicare Direct, available in Montgomery County, North Carolina. It offers all of the basic benefits of Original Medicare and may include additional coverage.
With an HMO plan, like this one from FirstMedicare Direct, your out-of-pocket costs are much lower than Original Medicare. That's the big advantage.
IMPORTANT: You must use providers in the FirstMedicare Direct network to avoid incurring additional costs. You are responsible for all costs incurred out of network. Referrals are generally required to see specialists.
The monthly premium for this plan in Montgomery County, NC is $10.00. This amount is paid directly to FirstMedicare Direct.
If you enroll in this plan you will pay your Medicare Part B premium plus this plan's monthly premium. Most people pay the standard Part B premium, but some beneficiaries pay higher Part B premiums due to their annual income (over $85k for singles or $170k for married couples). Late enrollment penalties can also increase your Part B premium.
In addition to the premiums you also pay your share when you use healthcare services. Each time you see your doctor, or if you are admitted as an inpatient (hospitalized), you'll pay copayments. Your prescription drugs also have a cost sharing component.
Maximum Out-of-Pocket Limit
2018 Medicare Advantage plans have an annual maximum out-of-pocket (MOOP) limit that protects you from financial disaster. The MOOP limit is $6,700, but plans can go as low as $3,400.
The most you will pay out-of-pocket if you enroll in this plan is $6,000. This amount does not include your monthly premium or the copayments. This is only the amount that you pay out of pocket.
Don't forget to look at the co-payments and co-insurance with Original Medicare (no out-of-pocket limits). If you stay on Original Medicare you'll need a Medicare Supplement to pay the gaps or pay it yourself.
Coverage, Copayments & Coinsurance
The FirstMedicare Direct HMO Standard plan offers the same basic benefits as Original Medicare. The big difference is copayments and coinsurances. Below you will find (where available) what you will pay for common health care services.
Most plans have copayments when you see your primary care doctor or a specialist. Here's how this plan works:
|Primary Care Doctor:||$30 co-payment|
|Physician Specialist:||$50 co-payment|
|Occupational Therapist:||$40 co-payment|
|Physical Therapist:||$40 co-payment|
|Speech Terapist:||$40 co-payment|
If you are admitted to a hospital or clinic for treatment and stay overnight, you are an inpatient. Most plans have tiered costs for inpatient treatment. Here's how this plan covers you:
- Day 1 to 6: $300
- Day 7 to 90: $0
The following preventative healthcare services are covered at no cost:
- Abdominal aortic aneurysm screening
- Alcohol misuse counseling
- Bone mass measurement
- Breast cancer screening (mammogram)
- Cardiovascular disease (behavioral therapy)
- Cardiovascular screenings
- Cervical and vaginal cancer screening
- Colorectal cancer screenings
- Depression screening
- Diabetes screenings
- HIV screening
- Medical nutrition therapy services
- Obesity screening and counseling
- Prostate cancer screenings (PSA)
- Sexually transmitted infections screening and counseling
- Tobacco use cessation counseling
- Vaccines including Flu shots Hepatitis B shots Pneumococcal shots
- Welcome to Medicare preventive visit
- Yearly Wellness visit
Prescription Drug Coverage
This plan includes Medicare Part D coverage for your prescription medications. The table below outlines what you will pay (the copayment) at your pharmacy for medications at each tier level.
|6||Select Care Drugs||%|
|6||Select Care Drugs||%|
If you are entitled to Part D assistance, your premium will be adjusted based on your percentage.
The Part D deductible on plan is $300.00. This is the amount you will pay until the plan begins to pay its portion.
Medicare Plan Rating
Medicare gave the FirstMedicare Direct HMO Standard plan an average rating of -1.0 out of 5 stars. This rating is , by Medicare's definition.
Medicare rates the quality of all Medicare Advantage plans. Ratings help shopper considering enrollment. Five stars represents the best quality. Plans rated less than 2.5 stars cannot be sold.
Compare FirstMedicare Direct HMO Standard with these top rated plans available in Montgomery County:
- Blue Medicare HMO Medical Only
- Blue Medicare HMO Essential
- HumanaChoice H5216-015
- FirstMedicare Direct HMO Plus
- FirstMedicare Direct PPO Plus
FirstMedicare Direct HMO Standard Availability
FirstMedicare Direct HMO Standard is available in Mount Gilead, Star, Biscoe, Ether, Candor, Troy, and all other areas of Montgomery County.
This page was last updated on 10/14/2017.
Plan data on Medicare-Plans.net comes from CMS.gov and is subject to change. The Centers for Medicare and Medicaid Services has neither reviewed nor endorsed the information on this site.
This page is a brief summary, not a complete description. Limitations, co-payments, and restrictions may apply. For more information contact the plan directly.
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