New Hanover Health Advantage Select (HMO-POS)

New Hanover Health Advantage Select (HMO-POS) H6306-013 Plan Details
4 out of 5 stars

New Hanover Health Advantage Select (HMO-POS) is a HMO-POS Medicare Advantage (Medicare Part C) plan offered by The Carle Foundation
Plan ID: H6306-013

Have Medicare questions?

Talk to a licensed agent today to find a plan that fits your needs.

$0.00
Monthly Premium

New Hanover Health Advantage Select (HMO-POS) is a HMO-POS Medicare Advantage (Medicare Part C) plan offered by The Carle Foundation
Plan ID: H6306-013

Have Medicare questions?

Talk to a licensed agent today to find a plan that fits your needs.

New Hanover Health Advantage Select (HMO-POS) H6306-013 Plan Details
4 out of 5 stars

New Hanover Health Advantage Select (HMO-POS) is a HMO-POS Medicare Advantage (Medicare Part C) plan offered by The Carle Foundation
Plan ID: H6306-013

Have Medicare questions?

Talk to a licensed agent today to find a plan that fits your needs.

$0.00
Monthly Premium

North Carolina Counties Served

Basic Costs and Coverage

Coverage Cost
Monthly Deductible $100
Out of Pocket Max In-Network: $3600
Out-of-Network: N/A
Initial Coverage Limit $5030
Catastrophic Coverage Limit $8,000
Primary Care Doctor Visit
In-Network:

Doctor Office Visit:
Copayment for Primary Care Office Visit $0.00
POS (Out-of-Network):

Doctor Office Visit:
Copayment for Medicare Covered Primary Care Office Visit $0.00
Specialty Doctor Visit
In-Network:

Doctor Specialty Visit:
Copayment for Physician Specialist Office Visit $25.00
POS (Out-of-Network):

Doctor Specialty Visit:
Copayment for Medicare Covered Physician Specialist Office Visit $50.00
Inpatient Hospital Care
In-Network:

Acute Hospital Services:
$300.00 per day for days 1 to 6
$0.00 per day for days 7 to 90
Prior Authorization Required for Acute Hospital Services
Prior authorization required
Out-of-Network:
$450.00 per day for days 1 to 6
$0.00 per day for days 7 to 90
Urgent Care
Copayment for Urgent Care $40.00

Worldwide Coverage:
Copayment for Worldwide Urgent Coverage $40.00
Maximum Plan Benefit of $10,000
Emergency Room Visit
Copayment for Emergency Care $135.00
Copayment for Medicare Covered Emergency Care waived if you are admitted to the hospital

Worldwide Coverage:
Copayment for Worldwide Emergency Coverage $135.00
Copayment for Worldwide Emergency Transportation $265.00
Maximum Plan Benefit of $10,000
Ambulance Transportation
In-Network:

Ground Ambulance:
Copayment for Ground Ambulance Services $265.00

Air Ambulance:
Copayment for Air Ambulance Services $265.00

Please see Evidence of Coverage for Prior Authorization rules
Prior authorization required
POS (Out-of-Network):

Ambulance Services:
Copayment for Medicare Covered Ambulance Services - Ground $265.00
Copayment for Medicare Covered Ambulance Services - Air $265.00

Health Care Services and Medical Supplies

New Hanover Health Advantage Select (HMO-POS) covers additional benefits and services, some of which may not be covered by Original Medicare (Medicare Part A and Part B).

Coverage Cost
Chiropractic Services
In-Network:
Copayment for Medicare-covered Chiropractic Services $20.00
Prior Authorization Required for Chiropractic Services
Prior authorization required
POS (Out-of-Network):
Copayment for Medicare Covered Chiropractic Services $50.00
Diabetes Supplies, Training, Nutrition Therapy and Monitoring
In-Network:
Coinsurance for Medicare-covered Diabetic Supplies 0% to 20%
Coinsurance for Medicare-covered Diabetic Therapeutic Shoes or Inserts 20%
Prior Authorization Required for Diabetic Supplies and Services
Diabetic Supplies and Services limited to those from specified manufacturers(Please see Evidence of Coverage)
Prior authorization required
POS (Out-of-Network):
Coinsurance for Medicare Covered Diabetic Supplies and Services 20%
Durable Medical Eqipment (DME)
In-Network:
Coinsurance for Medicare-covered Durable Medical Equipment 20%
Prior Authorization Required for Durable Medical Equipment
Prior authorization required
POS (Out-of-Network):
Coinsurance for Medicare Covered Durable Medical Equipment 20%
Diagnostic Tests, Lab and Radiology Services, and X-Rays
In-Network:

Outpatient Diag Procs/Tests/Lab Services:
Copayment for Medicare-covered Diagnostic Procedures/Tests $0.00 to $85.00
Copayment for Medicare-covered Lab Services $0.00 to $50.00
Prior Authorization Required for Outpatient Diag Procs/Tests/Lab Services

Outpatient Diag/Therapeutic Rad Services:
Copayment for Medicare-covered Diagnostic Radiological Services $0.00 to $275.00
Copayment for Medicare-covered Therapeutic Radiological Services $35.00
Coinsurance for Medicare-covered Therapeutic Radiological Services 20%
Copayment for Medicare-covered X-Ray Services $0.00 to $100.00
Prior Authorization Required for Outpatient Diag/Therapeutic Rad Services
Prior authorization required
POS (Out-of-Network):

Outpatient Diag Procs/Tests/Lab Services:
Coinsurance for Medicare Covered Diagnostic Procedures/Tests 40%
Coinsurance for Medicare Covered Lab Services 40%
Coinsurance for Medicare Covered Diagnostic Radiological Services 40%
Coinsurance for Medicare Covered Therapeutic Radiological Services 40%
Coinsurance for Medicare Covered Outpatient X-Ray Services 30%
Home Health Care
In-Network:
Copayment for Medicare-covered Home Health Services $0.00
Mental Health Inpatient Care
In-Network:

Psychiatric Hospital Services:
$160.00 per day for days 1 to 10
$0.00 per day for days 11 to 90
Prior Authorization Required for Psychiatric Hospital Services
Prior authorization required
Out-of-Network:
$285.00 per day for days 1 to 10
$0.00 per day for days 11 to 90
Mental Health Outpatient Care
In-Network:
Copayment for Medicare-covered Individual Sessions $35.00
Copayment for Medicare-covered Group Sessions $35.00
POS (Out-of-Network):
Copayment for Medicare Covered Individual Sessions $50.00
Copayment for Medicare Covered Group Sessions $50.00
Outpatient Services / Surgery
In-Network:

Outpatient Hospital Services:
Copayment for Medicare Covered Outpatient Hospital Services $265.00
Prior Authorization Required for Outpatient Hospital Services

Outpatient Observation Services:
Copayment for Medicare Covered Observation Services - Per stay $265.00
Prior Authorization Required for Outpatient Observation Services

Ambulatory Surgical Center Services:
Copayment for Ambulatory Surgical Center Services $215.00
Prior Authorization Required for Ambulatory Surgical Center Services
Prior authorization required
POS (Out-of-Network):

Outpatient Hospital and ASC Services:
Copayment for Medicare Covered Outpatient Hospital Services $450.00
Copayment for Medicare Covered Ambulatory Surgical Center Services $350.00
Outpatient Substance Abuse Care
In-Network:
Copayment for Medicare-covered Individual Sessions $35.00
Copayment for Medicare-covered Group Sessions $35.00
POS (Out-of-Network):
Copayment for Medicare Covered Individual or Group Sessions $50.00
Over-the-counter (OTC) Items
In-Network:

Over-The-Counter (OTC) Items:
Copayment for Over-The-Counter (OTC) Items $0.00
Maximum Plan Benefit of $60.00 every three months
Podiatry Services
In-Network:
Copayment for Medicare-Covered Podiatry Services $35.00
POS (Out-of-Network):
Copayment for Medicare Covered Podiatry Services $50.00
Skilled Nursing Facility Care
In-Network:

Skilled Nursing Facility Services:
$0.00 per day for days 1 to 20
$203.00 per day for days 21 to 41
$0.00 per day for days 42 to 100
Prior Authorization Required for Skilled Nursing Facility Services
Prior authorization required

Dental Benefits

The following dental services are covered from in-network providers.

Coverage Cost
Dental Care
In-Network:

Medicare Covered Dental Services:
Copayment for Medicare Covered Comprehensive Dental $40.00
Non-Medicare Covered Dental Services:
Coinsurance for Non-Medicare Covered Preventive Dental 0%
Coinsurance for Non-Medicare Covered Comprehensive Dental 0% to 40%
Maximum Plan Benefit of $2000.00 every year

POS (Out-of-Network):

Medicare Covered Dental Services:
Copayment for Medicare Covered Comprehensive Dental $35.00
Non-Medicare Covered Dental Services:
Copayment for Non-Medicare Covered Preventive Dental $35.00
Coinsurance for Non-Medicare Covered Preventive Dental 0% to 50%
Copayment for Non-Medicare Covered Comprehensive Dental $35.00
Coinsurance for Non-Medicare Covered Comprehensive Dental 0% to 50%
Maximum Plan Benefit of $2000.00 every year
POS (Out-of-Network):

Medicare Covered Dental Services:
Copayment for Medicare Covered Comprehensive Dental $35.00
Non-Medicare Covered Dental Services:
Copayment for Non-Medicare Covered Preventive Dental $35.00
Coinsurance for Non-Medicare Covered Preventive Dental 0% to 50%
Copayment for Non-Medicare Covered Comprehensive Dental $35.00
Coinsurance for Non-Medicare Covered Comprehensive Dental 0% to 50%
Maximum Plan Benefit of $3000.00 every year

Vision Benefits

The following vision services are covered from in-network providers.

Coverage Cost
Vision Benefits
In-Network:

Eye Exams:
Copayment for Medicare Covered Benefits $0.00 to $35.00
Copayment for Routine Eye Exams $0.00
  • Maximum 1 Routine Eye Exam every year

Eyewear:
Coinsurance for Medicare-Covered Benefits 20%
Maximum Plan Allowance of $300.00 every year for all Non-Medicare covered eyewear
POS (Out-of-Network):

Medicare Covered Vision Services:
Copayment for Medicare Covered Eye Exams $50.00
Coinsurance for Medicare Covered Eyewear 20%
Non-Medicare Covered Vision Services:
Copayment for Non-Medicare Covered Eyewear $0.00
Maximum Plan Benefit of $300.00 every year

Hearing Benefits

The following hearing services are covered from in-network providers.

Coverage Cost
Hearing Benefits
In-Network:

Hearing Exams:
Copayment for Medicare Covered Benefits $35.00
Copayment for Routine Hearing Exams $0.00
  • Maximum 1 visit every year
Copayment for Fitting/Evaluation for Hearing Aid $0.00
  • Maximum 1 visit every year

Hearing Aids:
Copayment for Hearing Aids $0.00
  • Maximum 2 Hearing Aids every year
Maximum Plan Benefit of $750.00 every year per ear
Member will be able to purchase up to 2 hearing aids every year with a maximum benefit allowance of $750.00 per ear. Member is responsible for any amount after the benefit allowance has been applied. Hearing aids must be purchased through NationsHearing to have access to the benefit. Each hearing aid purchase includes three (3) follow-up provider visits for fitting and adjustments. These visits are available for 12 months following the hearing aid fitting date.
POS (Out-of-Network):

Medicare Covered Hearing Services:
Copayment for Medicare Covered Hearing Exams $50.00

Preventive Services and Health/Wellness Education Programs

The following services are covered from in-network providers.

Coverage Cost
Preventive Services and Health/Wellness Education Programs
In-Network:
$0.00 copay for Medicare Covered Preventive Services:

Abdominal aortic aneurysm screening
Alcohol misuse screenings & counseling
Bone mass measurements (bone density)
Cardiovascular disease screenings
Cardiovascular disease (behavioral therapy)
Cervical & vaginal cancer screening
Colorectal cancer screenings
Depression screenings
Diabetes screenings
Diabetes self-management training
Glaucoma tests
Hepatitis B (HBV) infection screening
Hepatitis C screening test
HIV screening
Lung cancer screening
Mammograms (screening)
Nutrition therapy services
Obesity screenings & counseling
One-time Welcome to Medicare preventive visit
Prostate cancer screenings(PSA)
Sexually transmitted infections screening & counseling
Shots:
  • COVID-19 shots
  • Flu shots
  • Hepatitis B shots
  • Pneumococcal shots
  • Tobacco use cessation
    Yearly "Wellness" visit
    POS (Out-of-Network):

    Medicare-covered Zero Dollar Preventive Services:
    Copayment for Medicare Covered Medicare-covered Preventive Services $0.00

    Prescription Drug Costs and Coverage

    The New Hanover Health Advantage Select (HMO-POS) plan offers the following prescription drug coverage, with an annual drug deductible of $100 (excludes Tiers 1 and 2) per year.

    Coverage
    Cost
    Coverage & Cost
    Annual Drug Deductible $100 (excludes Tiers 1 and 2)
    Preferred Generic
    • Standard mail order $2.00
    • Standard retail $2.00
    Generic
    • Standard mail order $8.00
    • Standard retail $8.00
    Annual Drug Deductible $100 (excludes Tiers 1 and 2)
    Preferred Generic
    • Standard mail order $6.00
    • Standard retail $4.00
    Generic
    • Standard mail order $20.00
    • Standard retail $16.00
    Annual Drug Deductible $100 (excludes Tiers 1 and 2)
    Preferred Generic
    • Standard mail order $0.00
    • Standard retail $6.00
    Generic
    • Standard mail order $0.00
    • Standard retail $24.00