WV Senior Advantage (HMO I-SNP)

West Virginia Institutional Special Needs I-SNP Plan (2024 Plan)


Monthly Premium

Your Cost
$40
by West Virginia Senior Advantage

Additional Coverage

HearingVision

Overall Government Star Rating

 5.0
out of 5 stars

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Plan Name
WV Senior Advantage (HMO I-SNP)
Insurance Carrier
West Virginia Senior Advantage
Plan Type
Institutional Special Needs Plan (I-SNP)
Network Type
HMO

WV Senior Advantage (HMO I-SNP) is a Institutional Special Needs Plan (I-SNP), which is available in West Virginia and offered by the health insurance company West Virginia Senior Advantage. 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
$40
Annual Deductible
$240 per year for in-network services.
Max Out-of-Pocket
$8,850
Primary doctor visit
20% coinsurance per visit
Specialist visit
20% coinsurance per visit
ER visit
$100 copay per visit (always covered)
Ambulance
20% coinsurance

WV Senior Advantage (HMO I-SNP) has a monthly premium cost of $40 per month, with an annual deductible of $240 per year for in-network services. and a maximum out of pocket cost sharing of $8,850 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 WV Senior Advantage (HMO I-SNP) are defined below.

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

WV Senior Advantage (HMO I-SNP) is a Medicare Advantage plan which does include Medicare Part D Prescription Drug coverage. Other common benefits included with Medicare Advantage plans are coverage for dental, vision, and hearing. WV Senior Advantage (HMO I-SNP) includes coverage for hearing, vision.

Medicare Advantage health plans can offer even more additional benefits. WV Senior Advantage (HMO I-SNP) includes coverage for the following additional benefits:

Other benefits

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

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, WV Senior Advantage (HMO I-SNP) received an overall government quality rating of 5.0 stars out of 5 stars.

WV Senior Advantage (HMO I-SNP) performed better 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
 5.0
 4.1
Summary rating of health plan quality
 5
 4.2
Staying healthy: screenings, tests, & vaccines
No Rating (new plan)
 2.9
Managing chronic (long term) conditions
 5
 3.3
Member experience with health plan
No Rating (new plan)
 4.3
Member complaints & changes in the health plan's performance
 5
 4.4
Health plan customer service
No Rating (new plan)
 4.7
Summary rating of drug plan quality
 4
 3.8
Drug plan customer service
 3
 4.0
Member complaints & changes in the drug plan's performance
 4
 4.2
Member experience with the drug plan
No Rating (new plan)
 3.9
Drug safety & accuracy of drug pricing
 4
 3.4

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.

WV Senior Advantage (HMO I-SNP) received 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.

WV Senior Advantage (HMO I-SNP) received 4 stars for its drug plan quality score which is better than the West Virginia State average drug plan quality score of 3.8 stars.


Monthly Premium
$40
Health Portion of Premium
$0
Drug Portion of Premium
$40
Health Plan Deductible
$240 per year for in-network services.
Health Plan Max Out-of-Pocket
$8,850 In-network
Nationwide Coverage included
No
Hearing Coverage included
Yes
Vision Coverage included
Yes
Dental Coverage included
No

Doctor Services

Primary doctor visit
20% coinsurance per visit
Specialist visit
20% coinsurance per visit

Tests, labs, & imaging

Diagnostic tests & procedures
20% coinsurance
Lab services
$0 copay
Diagnostic radiology services (like MRI)
20% coinsurance
Outpatient x-rays
20% coinsurance
Emergency care
$100 copay per visit (always covered)
Urgent care
20% coinsurance per visit (always covered)

Hospital Services

Inpatient hospital coverage
In 2024 the amounts for each benefit period are:
$1,632 deductible for days 1 through 60
$408 copay per day for days 61 through 90
Outpatient hospital coverage
20% coinsurance per visit

Skilled nursing facility

Skilled nursing facility
$0 copay

Preventive services

Preventive services
$0 copay

Ambulance

Ground ambulance
20% coinsurance

Therapy services

Occupational therapy visit
$0 copay
Physical therapy & speech & language therapy visit
$0 copay

Mental health services

Outpatient group therapy with a psychiatrist
20% coinsurance
Outpatient individual therapy with a psychiatrist
20% coinsurance
Outpatient group therapy visit
20% coinsurance
Outpatient individual therapy visit
20% coinsurance

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
20% coinsurance per item

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

TiersInitial coverage phaseGap coverage phaseCatastrophic coverage phase
Preferred Generic


Generic drugs :
25%

Brand-name drugs :
25%


Generic drugs :
$0 copay

Brand-name drugs :
$0 copay

Generic
Preferred Brand
Non-Preferred Drug
Specialty Tier

Part B Drugs

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

Hearing

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

Preventive Dental

Oral exam
Not covered
Cleaning
Not covered
Fluoride treatment
Not covered
Dental x-rays
Not covered

Comprehensive dental

Non-routine services
Not covered
Diagnostic services
Not covered
Restorative services
Not covered
Endodontics
Not covered
Periodontics
Not covered
Extractions
Not covered
Prosthodontics, other oral/maxillofacial surgery, other services
Not covered

Vision

Routine eye exam
$0 copay
Contact lenses
$0 copay
Eyeglasses (frames & lenses)
$0 copay
Eyeglass frames (only)
$0 copay
Eyeglass lenses (only)
$0 copay
Upgrades
$0 copay

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