Columbia Community Care and Spokane Community Care Review

Columbia Community Care and Spokane Community Care are both offered through Arcadian Health Plan.  Arcadian offers Medicare Health and Prescription drug coverage in several states.  Both of these plans are Medicare Advantage plans that are HMO’s.  Medicare Advantage plans offer alternative coverage to original Medicare and a prescription drug plan.  In order to see if these plans make sense for you we need to look at how they cover some of the most important health items.

Columbia Community Care Plus (HMO)

  • Premium – $25/monthly
  • Maximum Out of Pocket – $4,950
  • Referral required for specialists
  • Hospital copay – $225/day Days 1-7
  • Doctors visits – $0 = Primary; $20 = Specialists
  • Outpatient Surgery – $200
  • Labs – $0
  • Diagnostic Procedures and Tests – $0
  • X-rays – 20%
  • Part D Deductible – $0
  • Part D Drugs – Tier 1 = $2; Tier 2 = $15; Tier 3 = $45; Tier 4 = $89; Tier 5 = 33%
  • Most generics covered through the Coverage Gap
  • Dental cleanings and x-rays covered up to $1,000 for comprehensive dental benefits
  • Routine hearing exams not covered
  • Eye exam and glasses covered up to $100 every two years

Spokane Community Care Plus (HMO)

  • Premium – $0/monthly
  • Maximum Out of Pocket – $3,400
  • Referral required for specialists
  • Hospital copay – $250/day Days 1-7
  • Doctors visits – $0 = Primary; $20 = Specialists
  • Outpatient Surgery – $200
  • Labs – $0
  • Diagnostic Procedures and Tests – $0
  • X-rays – 20%
  • Part D Deductible – $0
  • Part D Drugs – Tier 1 = $4; Tier 2 = $15; Tier 3 = $45; Tier 4 = $89; Tier 5 = 33%
  • Most generics covered through the Coverage Gap
  • Dental cleanings and x-rays covered up to $1,000 for comprehensive dental benefits
  • Routine hearing exams for $20 copay and up to $1,500 for hearing aids
  • Eye exam and glasses covered up to $150 every two years

Spokane Community Care Dual Plus (HMO-SNP)

  • Must have both Medicare and Medicaid
  • Premium – $0/monthly
  • Maximum Out of Pocket – $3,400
  • Referral required for specialists
  • All services offered at $0 copay depending on level of Medicaid assistance
  • Drugs will be $0 – $6.50 based on level of LIS
  • Dental cleanings and x-rays covered up to $1,000 for comprehensive dental benefits
  • Routine hearing exam = $10; hearing covered up to $1,200
  • Eye exam and glasses covered up to $150
  • Transportation – $0 copay for up to 24 one way trips

You must live in one of the plan’s counties in order to enroll into the plan.  For example,  the Spokane Community Care Plus Plan is only available to Spokane County residence.  You must have Medicare and Medicaid in order to enroll into the Dual Plus plan.  Since these plans are HMO’s you will want to make sure your providers are in the plan’s network before enrolling.

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