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MetroPlus Select Plan (HMO SNP) 2012 Benefit Highlights
To be eligible for MetroPlus Select Plan (HMO), you must have Medicare Parts A and B; reside in Manhattan, Brooklyn, Queens or the Bronx; and not have End-Stage Renal Disease (ESRD).
In 2012, MetroPlus Select Plan (HMO SNP) provides all the benefits of Original Medicare PLUS:
• $0 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 - $0 copay for routine hearing test every year. Up to $500 for hearing aids every three years.
• $0 Diabetic Monitoring Supplies.
• Vision Services - $0 copay for one (1) pair of glasses or one (1) pair of Contacts 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
Select Evidence of Coverage English Spanish
Medicaid Advantage Handbook English Spanish
H0423_MKT0908v5 CMS APPROVED 10142011
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