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0738 20 AEP GTM 21 65+ Summary of Benefits V8 SP FNL 508

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0738 20 AEP GTM 21 65+ Summary of Benefits V8 SP FNL 508 Plan 65 Plus (HMO) Resumen de beneficios 2021 Este plan Medicare Advantage brinda más beneficios además de Original Medicare, por ejemplo, servicios dentales, de la vista y la audición, y acupuntura. Está pensado para quienes no califican para los programas que ayudan a pagar los costos de Medicare, como Ayuda Adicional o Medicaid. Ciudad de Nueva York y condado de Nassau Del 1 de enero de 2021 al 31 de diciembre de 2021 H3359 001 H3359_ MKT21_11 001 0738-20_M Resumen de beneficios Prima y deducible médico $ Prima mensual 0Deducible médico Consultas médicas $ (cuidado primario) 10 Copago Cuidado de especialista $45Copago Servicios dentales preventivos Servicios de la vista de rutina Servicios de la audición de rutina Acceso al cuidado a través de $ Teladoc y de la línea de ayuda Copago de enfermería las 24 horas del 0 día, los 7 días de la semana Medicamentos genéricos preferidos Comidas (después del alta) Programa de ejercicio físico SilverSneakers® 2 Resumen de beneficios Índice Prima mensual Deducible médico Descripción general del Plan 65 Plus de Healthfirst ..............................................4 Contactos útiles ............................................................................................................ 7 Información útil .............................................................................................................8 Primas, deducibles y gastos directos de bolsillo .................................................. 10 Comparación de los beneficios médicos y hospitalarios con cobertura (costos dentro de la red) de Original Medicare con los del Plan 65 Plus de Healthfirst ....................................................................11 Beneficios de medicamentos recetados de la Parte D ....................................... 21 Preguntas frecuentes acerca del Plan 65 Plus de Healthfirst .............................25 Comunicación con Healthfirst ................................................................................. 27 Glosario ........................................................................................................................29 3 Descripción general del Plan 65 Plus de Healthfirst El Plan 65 Plus de Healthfirst les ofrece a los miembros una gran variedad de beneficios además de los que incluye Original Medicare, incluidos servicios dentales de rutina e integrales, la cobertura de servicios para la audición y audífonos, la cobertura de servicios de la vista, anteojos y lentes de contacto, acupuntura, comidas (después de recibir el alta), SilverSneakers® y acceso al cuidado las 24 horas del día, los 7 días de la semana mediante la Línea de Ayuda de Enfermería y Teladoc. Además, no necesita una remisión para consultar con los especialistas. 4 Este plan puede ser el Definiciones útiles adecuado para quienes no Organización de Mantenimiento califican para los programas de la Salud (HMO, por sus siglas que ayudan a pagar los en inglés) gastos de Medicare, como Es un tipo de plan de seguro médico. En la Ayuda adicional (también mayoría de los planes HMO, usted solo denominada Subsidio por puede ir a los hospitales, médicos y otros bajos ingresos), los Programas proveedores de cuidado médico que tienen acuerdos con el plan, excepto en caso de una de Ahorros de Medicare emergencia. Es posible que también necesite (MSP, por sus siglas en inglés) una remisión por parte de su médico de o Medicaid. cuidado primario antes de consultar con un especialista; sin embargo, con el Plan 65 Plus Si cree que podría calificar de Healthfirst, en ningún caso necesitará una para alguno de estos remisión para consultar a un especialista. programas, llámenos y le Prima ayudaremos a encontrar el Importe de dinero que algunas personas plan de Healthfirst adecuado pagan mensual, trimestral o bianualmente para usted. para recibir cobertura por parte de un Llame al 1-877-237-1303, programa o plan de seguro médico. de 8:00 a.m. a 8:00 p.m., Pago complementario (o copago) los 7 días de la semana Tarifa que usted paga cada vez que va al (TTY en inglés y otros idiomas médico, surte su medicamento recetado o recibe otros servicios. 1-888-542-3821) (TTY en español 1-888-867-4132). Coseguro La tarifa que usted le debe al médico por su Healthfirst quiere asegurarse de que usted cuidado después de alcanzar su deducible reciba todos los recursos que necesita para anual. La cantidad que usted debe es una mantenerse saludable. Es por eso que les parte del costo de su cuidado. ofrecemos a los miembros el Plan 65 Plus Su compañía de seguros paga el resto. de Healthfirst, con más asistencia en un servicio que les ayuda a conectarse con los ¿Qué le hace elegible para ser programas de su comunidad. Puede ayudarles miembro del plan? en lo que necesiten e incluso hacerles ahorrar en los costos de cuidado médico. • Tiene las Partes A y B de Medicare Este documento es un resumen y no incluye • Vive en la ciudad de Nueva York o en el todos los servicios que están cubiertos ni condado de Nassau detalla cada limitación o exclusión. Para • Es ciudadano de los Estados Unidos o está obtener una lista completa de los servicios, legalmente presente en los Estados Unidos consulte su Evidencia de cobertura (EOC, por sus siglas en inglés), que puede consultarla en línea en HFMedicareMaterials.org o llamando al 1-888-260-1010 (TTY 1-888-867-4132) para solicitar que le envíen una copia por correo. 5 66 Contactos útiles Fecha de entrada en vigencia del plan Nombre del representante de ventas de Healthfirst Número de teléfono Nombre del proveedor de cuidado primario Dirección Número de teléfono Sitio web de Healthfirst SilverSneakers healthfirst.org/medicare 1-888-423-4632 TTY 711 Planes Medicare Advantage de Healthfirst De lunes a viernes, de 8:00 a.m. a 8:00 p.m. (para no miembros) 1-877-237-1303 NationsHearing TTY 1-888-867-4132 1-877-438-7251 De 8:00 a.m. a 8:00 p.m., TTY 711 los 7 días de la semana De lunes a viernes, de 8:00 a.m. a 8:00 p.m. Servicios a los Miembros de Healthfirst Medicare 1-888-260-1010 1-800-MEDICARE (1-800-633-4227) TTY 1-888-867-4132 TTY 1-877-486-2048 De 8:00 a.m. a 8:00 p.m., Las 24 horas del día, los 7 días de la semana. los 7 días de la semana medicare.gov Teladoc Programa de Cobertura de Seguro de Productos 1-800-TELADOC (1-800-835-2362) Farmacéuticos para Personas Mayores TTY 1-800-877-8973 (EPIC, por sus siglas en inglés) Los 7 días de la semana, las 24 horas del día 1-800-332-3742 TTY 1-800-290-9138 Línea de Ayuda de Enfermería De lunes a viernes, de 8:30 a.m. a 5:00 p.m. 1-855-NURSE33 (1-855-687-7333) Los 7 días de la semana, las 24 horas del día Beneficios de farmacia TTY 711 1-888-260-1010 TTY 711 DentaQuest Las 24 horas del día, los 7 días de la semana 1-800-508-2047 TTY 1-800-466-7566 Seguro Social De lunes a viernes, de 9:00 a.m. a 6:00 p.m. 1-800-772-1213 TTY 1-800-325-0778 Davis Vision De lunes a viernes, de 7:00 a.m. a 7:00 p.m. 1-800-753-3311 De lunes a viernes, de 8:00 a.m. a 11:00 p.m.; Transporte sábados de 9:00 a.m. a 4:00 p.m.; 1-888-260-1010 domingos de 12:00 p.m. a 4:00 p.m. TTY 1-888-867-4132 Los 7 días de la semana 7 Información útil Directorio de proveedores y farmacias La mejor forma de buscar un médico o un especialista y una farmacia dentro de la red de Healthfirst es visitando HFDocFinder.org. También puede visitar alguna de nuestras convenientes oficinas locales (visite healthfirst.org para encontrar la más cercana a usted). O llame a Servicios a los Miembros al 1-888-260-1010 (TTY 1-888-867-4132) para solicitar asistencia. Formulario de Healthfirst Para descargar una copia del Formulario de su Plan Medicare de Healthfirst, visite HFMedicareMaterials.org. También puede recoger uno en alguna oficina local de Healthfirst. El formulario es una lista de medicamentos recetados (tanto genéricos como de marca) cubiertos por su plan de salud. Medicare y usted Visite medicare.gov para ver el manual en línea o pida una copia llamando al 1-800-MEDICARE (1-800-633-4227, TTY 1-877-486-2048). Puede llamar las 24 horas del día, los 7 días de la semana o visitar medicare.gov en la web. También puede descargar una copia del manual en medicare.gov/medicare-and-you/medicare-and-you.html. Palabra que debe conocer en esta página: Formulario Para saber qué significa esta palabra, consulte el Glosario en la página 29. 8 Aplicación para teléfonos móviles de Healthfirst NY La aplicación para teléfonos móviles de Healthfirst NY le permite tener acceso al cuidado de la salud al alcance de la mano. Utilícela para encontrar servicios esenciales cercanos en su comunidad, comunicarse con un representante de la Oficina local de Healthfirst, visualizar su información de afiliación y más. Estamos trabajando las 24 horas del día para que pueda conectarse con el cuidado que necesita, y esperamos que pueda tener nuevas funciones a su disposición. Los miembros de Healthfirst pueden: ■ Acceder a su número de identificación digital y guardarlo, enviarlo por correo electrónico o por mensaje de texto. ■ Encontrar servicios esenciales cercanos, como alimentos, vivienda, educación, empleo, planificación familiar, asistencia financiera y legal, y más. ■ Encontrar farmacias, clínicas de salud minoristas, centros de atención de urgencia y otros proveedores. ■ Usar nuestra oficina local virtual de Healthfirst para buscar un representante de ventas por distrito, ubicación de oficina, idioma y género. ■ Acceder a Teladoc para hablar con médicos certificados por la junta médica de EE. UU. las 24 horas del día, los 7 días de la semana, por teléfono o videollamada. ■ Comunicarse con Servicios a los Miembros de Healthfirst para obtener respuestas sobre los beneficios. ■ Recibir notificaciones instantáneas en su dispositivo para mantenerse informado, conocer nuevas funciones y más.
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