The Health Plan SecureCare Integrity Plan 1 (HMO)

West Virginia Medicare Advantage Plan (2024 Plan)


Monthly Premium

Your Cost
$0
by The Health Plan

Additional Coverage

HearingVisionDental

Overall Government Star Rating

 4.0
out of 5 stars

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Plan Name
The Health Plan SecureCare Integrity Plan 1 (HMO)
Insurance Carrier
The Health Plan
Plan Type
Medicare Advantage Plan Without Prescription Drugs
Network Type
HMO

The Health Plan SecureCare Integrity Plan 1 (HMO) is a Medicare Advantage Plan Without Prescription Drugs, which is available in West Virginia and offered by the health insurance company The Health Plan. This plan’s network type is HMO which determines in-network doctors who accept the health plan and whether a referral is needed.

Monthly Premium
$0
Annual Deductible
$0
Max Out-of-Pocket
$5,900
Primary doctor visit
$0 copay
Specialist visit
$35 copay per visit
ER visit
$110 copay per visit (always covered)
Ambulance
$250 copay

The Health Plan SecureCare Integrity Plan 1 (HMO) has a monthly premium cost of $0 per month, with an annual deductible of $0 and a maximum out of pocket cost sharing of $5,900 In-network. The most common benefit costs which people evaluate when choosing a plan are costs for a primary doctor visit, specialist doctor visit, emergency room visit, and ambulance. These costs are listed in this summary section and a full list of benefit costs for The Health Plan SecureCare Integrity Plan 1 (HMO) are defined below.

No
Part D Prescription Drug Coverage
Yes
Dental
Yes
Vision
Yes
Hearing

The Health Plan SecureCare Integrity Plan 1 (HMO) is a Medicare Advantage plan which does not include Medicare Part D Prescription Drug coverage. Other common benefits included with Medicare Advantage plans are coverage for dental, vision, and hearing. The Health Plan SecureCare Integrity Plan 1 (HMO) includes coverage for hearing, vision, dental.

Medicare Advantage health plans can offer even more additional benefits. The Health Plan SecureCare Integrity Plan 1 (HMO) includes coverage for the following additional benefits:

Other benefits

Fitness benefit
Limited coverage
Over the counter drug benefits
Limited coverage
In-home support services
Not covered
Home and bathroom safety devices
Not covered
Meals for short duration
Limited coverage
Annual physical exams
Limited coverage
Telehealth
Limited coverage

Each year the federal government evaluates the quality of Medicare Advantage and Part D Prescription Drug plans based on a 5-star scoring system. For 2024, The Health Plan SecureCare Integrity Plan 1 (HMO) received an overall government quality rating of 4.0 stars out of 5 stars.

The Health Plan SecureCare Integrity Plan 1 (HMO) performed worse than West Virginia’s State average overall quality score of 4.1 stars.

This Plan’s 5-star Gov’t Quality Score
West Virginia State Average Score
Overall Government 5 Star Quality Rating
 4.0
 4.1
Summary rating of health plan quality
 4.5
 4.2
Staying healthy: screenings, tests, & vaccines
 3
 2.9
Managing chronic (long term) conditions
 3
 3.3
Member experience with health plan
 5
 4.3
Member complaints & changes in the health plan's performance
 5
 4.4
Health plan customer service
No Rating (new plan)
 4.7

The government calculates an “Overall star rating” based on ratings for sub components including “Health plan star rating” and “Drug plan star rating”, which includes further subcomponents of each.

The Health Plan SecureCare Integrity Plan 1 (HMO) received 4.5 stars for its health plan quality score which is better than the West Virginia State average health plan quality score of 4.2 stars.


Monthly Premium
$0
Health Portion of Premium
$0
Drug Portion of Premium
$0
Health Plan Deductible
$0
Health Plan Max Out-of-Pocket
$5,900 In-network
Nationwide Coverage included
No
Hearing Coverage included
Yes
Vision Coverage included
Yes
Dental Coverage included
Yes
Doctor Lookup Link

Doctor Services

Primary doctor visit
$0 copay
Specialist visit
$35 copay per visit

Tests, labs, & imaging

Diagnostic tests & procedures
$50 copay
Lab services
$0 copay
Diagnostic radiology services (like MRI)
$0-150 copay
Outpatient x-rays
$50 copay
Emergency care
$110 copay per visit (always covered)
Urgent care
$40 copay per visit (always covered)

Hospital Services

Inpatient hospital coverage
$295 per day for days 1 through 6
$0 per day for days 7 through 90
Outpatient hospital coverage
$0-250 copay per visit

Skilled nursing facility

Skilled nursing facility
$0 per day for days 1 through 20
$150 per day for days 21 through 100

Preventive services

Preventive services
$0 copay

Ambulance

Ground ambulance
$250 copay

Therapy services

Occupational therapy visit
$40 copay
Physical therapy & speech & language therapy visit
$40 copay

Mental health services

Outpatient group therapy with a psychiatrist
$35 copay
Outpatient individual therapy with a psychiatrist
$35 copay
Outpatient group therapy visit
$35 copay
Outpatient individual therapy visit
$35 copay

Opioid treatment services

Opioid treatment services
Covered

Other services

Durable medical equipment (like wheelchairs & oxygen)
20% coinsurance per item
Prosthetics (like braces, artificial limbs)
20% coinsurance per item
Diabetes supplies
0-20% coinsurance per item

Tier drug costs for: Standard retail pharmacy drug cost for 1-month

Part B Drugs

Chemotherapy drugs
0-20% coinsurance
Other Part B drugs
0-20% coinsurance

Hearing

Hearing exam
$35 copay
Fitting/evaluation
$0 copay
Hearing aids - All types
$599-899 copay

Preventive Dental

Oral exam
$0 copay
Cleaning
$0 copay
Fluoride treatment
Not covered
Dental x-rays
$0 copay

Comprehensive dental

Non-routine services
Not covered
Diagnostic services
$0 copay
Restorative services
0-50% coinsurance
Endodontics
0-50% coinsurance
Periodontics
0-50% coinsurance
Extractions
0-50% coinsurance
Prosthodontics, other oral/maxillofacial surgery, other services
0-50% coinsurance

Vision

Routine eye exam
$0 copay
Contact lenses
$0 copay
Eyeglasses (frames & lenses)
Not covered
Eyeglass frames (only)
$0 copay
Eyeglass lenses (only)
$0 copay
Upgrades
Not covered

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