Medicare Plans Information

 

If you live in Alamosa, Conejos, Costilla, Mineral, Rio Grande, and/or Saguache Counties, click on the Evidence of Coverage below to view the detailed benefit information for contract year 2018. This information provides comprehensive benefit information and explains covered & non-covered benefits, what to do if you are unhappy with our services and other detailed plan information.

Plan                                                                                                                                       Premium*

Friday Health Plans Silver SV Plan (Cost) Evidence of Coverage                                   $30

Friday Health Plans Silver SV Plan (Cost) Evdencia de Cobertura (Español)

Friday Health Plans Gold SV Plan (Cost) Evidence of Coverage                                     $50

Friday Health Plans Gold SV Plan (Cost) Evidencia de Cobertura (Español)

Friday Health Plans Platinum SV Plan (Cost) Evidence of Coverage                               $80

Friday Health Plans Platinum SV Plan (Cost) Evidencia de Cobertura (Español)

Benefits Silver SV Gold SV Platinum SV
Premium $30 $50 $80
Deductible None None None
MOOP $6,700 $6,700 $6,700
Inpatient $1175 copay $850 copay $750 copay
Primary Care Visit $35 copay $25 copay $20 copay
Specialist Visit $50 copay $40 copay $35 copay
Emergency Care $75 copay $75 copay $75 copay
Urgent Services $40 copay $35 copay $30 copay
Preventive Services $0 $0 $0
Diagnostics 20% of cost 20% of cost 20% of cost
Outpatient Surgery $300 $250 $200
Hearing Services $35 copay $30 copay $25 copay
Skilled Nursing  

$0 days 1-20
$167.50 days 21-100

 

$0 days 1-20
$167.50 days 1-20

 

$0 days 1-20
$167.50 days 21-100

Ambulance $150 copay $150 copay $150 copay
DME 20% of the cost 20% of the Cost 20% of the cost
 

This list is not all-exclusive. For a complete list of cost-sharing, including any conditions and limitation please refer to the Evidence of Coverage.

 

Click on the Summary of Benefits document below for an overview and comparison of our plans and benefits for San Luis Valley Counties.

2018 Summary of Benefits SV

2018 Summary of Benefits (Spanish Version)

*You must continue to pay your Medicare Part B premium. Benefits, premium and/or copayments/coinsurance may change each year on January 1. Benefits may be subject to copayments, limitations and/or restrictions. See the Evidence of Coverage or contact Customer Service for details.

If you live in Bent, Chaffee, Crowley, Custer, Fremont, Huerfano, Las Animas, Otero, Prowers, and/or  Yuma Counties. Click on the Evidence of Coverage below to view the detailed benefit information for contract year 2018. This information provides comprehensive benefit information and explains covered and non-covered benefits, what to do if you are unhappy with our services and other detailed plan information.

Plan                                                                                                                                        Premium*

Friday Health Plans Silver Plan (Cost) Evidence of Coverage                                         $30

Friday Health Plans Gold Plan (Cost) Evidence of Coverage                                           $50

Friday Health Plans Platinum Plan (Cost) Evidence of Coverage                                     $80

Benefits Silver Gold Platinum
Premium $30 $50 $80
Deductible None None None
MOOP $6,700 $6,700 $6,700
Inpatient $1175 copay $850 copay $750 copay
Primary Care Visit $35 copay $25 copay $20 copay
Specialist Visit $50 copay $40 copay $35 copay
Emergency Care $75 copay $75 copay $75 copay
Urgent Services $40 copay $35 copay $30 copay
Preventive Services $0 $0 $0
Diagnostics 20% of cost 20% of cost 20% of cost
Outpatient Surgery $300 $250 $200
Hearing Services $35 copay $30 copay $25 copay
Skilled Nursing  

$0 days 1-20
$167.50 days 21-100

 

$0 days 1-20
$167.50 days 1-20

 

$0 days 1-20
$167.50 days 21-100

Ambulance $150 copay $150 copay $150 copay
DME 20% of the cost 20% of the Cost 20% of the cost
 

This list is not all-exclusive. For a complete list of cost-sharing, including any conditions and limitation please refer to the Evidence of Coverage.

 

Click the Summary of Benefits link below for an overview and comparison of our plans and benefits for our service area outside of the San Luis Valley.

2018 Summary of Benefits

*You must continue to pay your Medicare Part B premium. Benefits, premium and/or copayments/coinsurance may change each year on January 1. Benefits may be subject to copayments, limitations and/or restrictions. See the Evidence of Coverage or contact Customer Service for details.

READY TO ENROLL

MEDICARE ENROLLMENT APPLICATION

Now that you’ve selected the plan that’s right for you, it’s easy for you to enroll!

All you have to do is click the button below to download an Application, complete it, sign it, and mail it to us at:

Friday Health Plans

Attn: Enrollment – Medicare

700 Main Street, Suite 100

Alamosa, CO  81101

It’s that simple!

If you live in Alamosa, Conejos, Costilla, Mineral, Rio Grande and/or Saguache Counties, click below to download an application.

2018 Medicare Enrollment Application SV

2018 Solicitud de Medicare SLV (Español)

If you live in Bent, Chaffee, Crowley, Custer, Fremont, Huerfano, Las Animas, Otero, Prowers, and Yuma Counties, click below to download an application.

2018 Medicare Enrollment Application

PLAN RATINGS

Medicare evaluates plans based on a 5-star rating system. Star Ratings are calculated each year and may change from one year to the next.

2018 Medicare Star Ratings (Calificaciones por estrellas Medicare 2018)*

 

 

 

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