Evercare Medicare Plans
Evercare, a part of the massive United Healthcare organization, is an approved Medicare Advantage provider. Their Medicare Advantage plans include Medicare Part D Prescription Drug Coverage.* Evercare plans and services offered may vary by location, and their plans are available in 38 states throughout the country.
Approximately five years ago, Evercare was investigated for aggressive marketing practices to senior citizens in the Northeast area of the country. As a result, Medicare has stepped up oversight of the marketing practices of this company, as well as other providers, to ensure that they are providing truthful, comprehensive information to seniors.
Evercare Medicare Plan Details
Evercare specializes in Medicare Advantage Special Needs Plan primarily using Preferred Provider Organizations (SNP/PPO Plans). Evergreen plans not only provide full Medicare coverage and prescription drug coverage, but additional benefits for seniors with chronic illnesses, disabilities and advanced health issues. Their plans include:
- Evercare Health Plan for People with Limited Incomes — Offers benefits designed for people with both Medicare and Medicaid living in community settings. Plans provide more benefits than Original Medicare, such as transportation to medical appointments and vision exams. Evercare also helps coordinate Medicare and Medicaid benefits for members.
- Evercare Health Plan for People in Nursing Homes — Provides individualized, closely monitored and coordinated care to nursing home residents in Evercare contracted facilities. Evercare Nurse Practitioners work with physicians, facilities, members, and the member’s family to coordinate care across all settings.
- Evercare Health Plan for People with Specific Long-Term Illnesses — Offers benefits and services tailored to meet the needs of people living with specific chronic conditions including, diabetes, cardiovascular disease and congestive heart failure. In addition to preventative care and other benefits not covered by Original Medicare, members are aligned with programs to help coordinate care and keep them healthy.
As of 2010, the benefits provided by an average Evergreen Preferred Provider plan include:
- No referrals required for network doctors, specialists, and hospitals. You can go to doctors, specialists, and hospitals in or out of the network; although it will cost more for out of network benefits.
- Plan covers up to 100 days of a Skilled Nursing Facility stay with no co-pay nor prior hospital stay required.
- A $5,000 out-of-pocket limit.
- No co-pay for each primary care doctor visit for Medicare-covered benefits.
- 20% of the cost for each in-area, network urgent care Medicare-covered visit.
- $50 co-pay for Medicare-covered emergency room visits.
- No co-pay for Medicare-covered lab services and x-rays.
- 0% to 20% of the cost for Medicare-covered diagnostic procedures and tests.
The annual costs to an average user of Evercare benefits, which includes premium costs, co-pays, uncovered medical costs, and any deductibles, is estimated to be approximately $4,000 in 2011.
The 2010 price estimate includes:
- Monthly Medicare Part B Premium of $110.50 (as of 2010);
- Monthly Drug Premium of $29;
- Estimated cost of annual inpatient care of $32;
- Estimated cost of average outpatient prescription drugs of $118;
- Estimated cost of average annual dental services of $27;
- Estimated cost of average other services of $30.
- This results in an average monthly cost of $332.
This plan covers all Medicare-covered preventive services with zero cost sharing in accordance with the Health Reform Act of 2010.
* You may be able to get extra help to pay for your prescription drug premiums and costs. To see if you qualify for getting extra help, call:
1-800-MEDICARE (1-800-633-4227). TTY/TDD users should call 1-877-486-2048, 24 hours a day/7 days a week;
The Social Security Administration at 1-800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday. TTY/TDD users should call, 1-800-325-0778; or Your State Medicaid Office