Southeast Community Care Plus HMO SC Virginia Review

Southeast Community Care is offered through Arcadian Health Plan.  Arcadian offers Medicare Health and Prescription drug coverage in several states.  Southeast Community Care Plus plan is a Medicare Advantage HMO plan that is available in Georgia, North and South Carolina, and Virginia.  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.

Southeast Community Care Plus (South Carolina)

  • Premium – $0/monthly
  • Maximum Out of Pocket – $3,900
  • Referral required for specialists
  • Hospital copay – $195/day Days 1-7; or $265/day Days 1-6
  • Doctors visits – $5 = Primary; $25 = Specialists; or $10 and $29
  • Outpatient Surgery – $200; or $250; or $300
  • 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%
  • In som counties some generics covered through the Coverage Gap
  • Dental cleanings and x-rays covered up to $1,000 for comprehensive dental benefits
  • Routine hearing exams up to a $29 copay and up to $1000 for hearing aids
  • Eye exam and glasses covered up to $150 every two years

Southeast Community Care Plus (Virginia)

  • Premium – $0/monthly
  • Maximum Out of Pocket – $3,000 or $3,600
  • Referral required for specialists
  • Hospital copay – $150/day Days 1-5; or $165/day Days 1-5
  • Doctors visits – $0 = Primary; $15 = Specialists; or $0 and $20
  • Outpatient Surgery – $175; or $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%
  • Dental cleanings and x-rays covered up to $1,000 for comprehensive dental benefits
  • Routine hearing exams up to a $20 copay and up to $1000 for hearing aids
  • Eye exam and glasses covered up to $150 every two years

Note:  The county you live in will determine what your copay is.  Always check your providers to make sure they are listed in the plan’s network before joining an HMO.  You should also consult with an independent insurance agent in order to make sure you are joining the best plan for you!

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