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MetroPlus Advantage Plan (HMO SNP) 2012 Benefit Highlights
To be eligible for MetroPlus Advantage Plan (HMO SNP), you must have Medicare Part A and B; reside in Manhattan, Brooklyn, Queens or the Bronx; and not have End-Stage Renal Disease (ESRD).
In 2012, MetroPlus Advantage Plan (HMO SNP) provides all the benefits of Original Medicare PLUS:
• $34.20 monthly plan premium, however, the amount you pay depends on your level of Extra Help. Click for Extra Help chart.
• $0 copay for Primary Care visits.
• Medicare Prescription Drug Coverage (Medicare Part D)
• Hearing Services - $10 copay for routine hearing test every year.
• $0 copay for Diabetic Monitoring Supplies.
• Vision Services - $0 copay for one (1) pair of glasses or one (1) pair of Contacts every year, plus $125 for eye glass frames every year.
• Dental Services - $0 copay for oral exams, cleanings, fluoride treatment and x-rays.
• Transportation - $0 copay for up to 12 round trips to any plan-approved location every year using New York City MTA.
• Specialized Care Management Programs, including AsthmaPlus and DiabetesCARE (plus Telehealth Program).
Advantage, Select and Partnership In Care Summary of Benefits English Spanish
Advantage Evidence of Coverage
English Spanish
H0423_MKT0908v5 CMS APPROVED 10142011
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