Western Slope Medicare Cost Plans

Western Slope Medicare Cost Plan Benefit Comparison Highlights 2016


Contact an RMHP's Medicare Salesperson


Do you have questions about our Western Slope Medicare Cost plans? To speak with a licensed RMHP's Medicare Salesperson, call 8:00 a.m. to 8:00 p.m., Mountain Time, (from October 1 - February 14, 7 days per week; from February 15 - September 30, M-F) at 888-251-1330 (TTY: 711). Para asistencia en español llame al 888-251-1330.   For Customer Service please call: 888-282-1420 or 970-244-7912 (TTY: 711)

Medicare Covered Benefit

Rocky Mountain
Green Plan (Cost)
You Pay

 

Rocky Mountain
Thrifty Plan (Cost)
You Pay

 

Rocky Mountain
Standard Plan (Cost)
You Pay

 

Rocky Mountain
Plus Plan (Cost)
You Pay

 
Monthly Plan Premium

Medical Only



$20.00*



$40.00*



$75.00*



$175.00*

Medical Deductible Applies to all services except Preventive Care, Primary Care Physician and Specialist Care office visits, diagnostic radiology, lab services, emergency room services, ambulance, and urgent care.
$600 per calendar year (annual deductible).  $450 per calendar year (annual deductible). 
None None
Medical out of pocket maximum  Medical Out of Pocket Maximum (OOP): The maximum amount a Member pays per plan year for in-network Medicare covered medical services. Typically includes deductible(s) and plan cost-sharing. Medicare-covered services do not include care received out of the country, routine vision or hearing exams, annual physical, hospice consultation or plan premiums.

$6,700 per calendar year.  $6000 per calendar year.  $4,500 per calendar year.  $4,500 per calendar year. 
Primary Care Physician
Office Visit Copayment

$25 per visit

$20 per visit

$20 per visit

$15 per visit

Specialist Care Physician
Office Visit Copayment

$55 per visit


$50 per visit


$45 per visit

$40 per visit

Inpatient Hospital Copayment

$350 copay per day up to 7 days per admission

$250 copay per day up to 5 days per admission

$700 per admission $500 per admission
Outpatient Surgery

$400 per visit

$400 per visit

$350 per visit

$300 per visit

Ambulance

$200 per trip


$200 per trip


$200 per trip

$100 per trip

Emergency Room

$75 per visit
Worldwide


$65 per visit
Worldwide

$65 per visit
Worldwide

$50 per visit
Worldwide
Urgent Care

$55 per visit
Worldwide


$50 per visit
Worldwide


$45 per visit
Worldwide

$40 per visit
Worldwide
Annual Routine Physical

$0

As an alternative to the Yearly "Wellness" visit, RMHP also covers a routine physical exam once every calendar year.

$0

As an alternative to the Yearly "Wellness" visit, RMHP also covers a routine physical exam once every calendar year.


$0

As an alternative to the Yearly "Wellness" visit, RMHP also covers a routine physical exam once every calendar year.

$0

As an alternative to
the Yearly
"Wellness" visit, RMHP also covers a routine physical exam once every calendar year.

Preventive Screening Services

$0


$0


$0

$0

Skilled Nursing Facility

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

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

$0, days 1-20
$95, days 21-100

$0, days 1-20
$95, days 21-100

Durable Medical Equipment

20% coinsurance

20% coinsurance

20% coinsurance

20% coinsurance

Diagnostics MRI/PET Scan/Nuclear Medicine: 20%
CT/Ultrasound: 20%
X-ray: $25
MRI/PET Scan/Nuclear Medicine: $200
CT/Ultrasound: $150
X-ray: $20

MRI/PET Scan/Nuclear Medicine: $150
CT/Ultrasound: $75
X-ray: $20
 
 
 
MRI/PET Scan/Nuclear Medicine: $150
CT/Ultrasound: $75
X-ray: $15


Silver&Fit Exercise & Healthy Aging Program Not Offered
A basic fitness center membership at participating fitness centers for a $75 yearly copay (paid directly to the fitness center).
Or

Two at-home fitness kits for a yearly $10 copay.
A basic fitness center membership at participating fitness centers for a $75 yearly copay (paid directly to the fitness center).
Or

Two at-home fitness kits for a yearly $10 copay.
A basic fitness center membership at participating fitness centers for a $75 yearly copay (paid directly to the fitness center).
Or

Two at-home fitness kits for a yearly $10 copay.
Enrollment Options
Enroll Online

Enroll Online


Enroll Online



Enroll Online

Part D For Optional Part D details, click here
For Optional Part D details, click here
For Optional Part D details, click here
For Optional Part D details, click here
 *plus you must continue to pay Medicare Part B premium 
View a printable Western Slope Medicare Cost Plan Highlights grid.


RMHP Western Slope Medical Only Medicare Cost plans are open for enrollment at any time.This information is not a complete description of benefits. Contact the plan for more information. People with End Stage Renal Disease (kidney failure) may enroll under certain circumstances. Limitations, copayments and restrictions may apply. Benefits, premium and/or copayments/co-insurance may change January 1 of each year. RMHP offers other Medicare Cost plans in addition to those shown here, for details contact the plan.

You may be able to get Extra Help to pay for your prescription drug premiums and costs. To see if you qualify for extra help, call:

  • 1-800-MEDICARE (1-800-633-4227).  TTY users should call 1-877-486-2048.  24 hours a day/7 days a week:
  • The Social Security Office at 1-800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday. TTY users should call 1-800-325-0778; or
  • Your State Medicaid Office

RMHP Western Slope Medicare Optional Plans

Get detailed information on Medicare Optional Plans.

Silver&Fit Exercise and Healthy Aging Program – For Thrifty, Standard and Plus plan Members

Silver&Fit Exercise and Healthy Aging program is designed specifically for our Medicare Members. Once you have registered, you will have access to Silver &Fit Connected.  This is an online data tracker that collects your activity and coverts it to points that can be used towards a reward program. The more points you get the more rewards you earn.

Enrolled Members will also receive a quarterly newsletter, Silver Slate that is geared toward nutrition, weight management and taking better care of oneself.  In addition to that, Members will receive access to 48 healthy aging education classes designed for at-home use. These can also be sent quarterly through the mail.

In addition to the online program, as an eligible Member you may choose from one of these two options:

1. Fitness Club Membership at a contracted Silver&Fit Network facility – Entitles you to take advantage of all of the services and amenities included with your fitness club or exercise center membership with a once per year fee of $75.00.

Silver&Fit Fitness Facility Directory

OR

2. Silver&Fit Home Fitness Program – This program offers you the chance to participate in fitness and education activities in the comfort of your own home with a $10.00 annual fee.  When you join Silver&Fit,  you may choose to receive up to two of the following kits:

  • Aquatics
  • Cardio Strength  Chair Aerobics for Everyone  
  • Chair Boxing  
  • Chair Dancing Through the Decades  
  • Chair Tai Chi    
  • Chair Yoga    
  • Exercise for bedridden and Physically Challenged  
  • High Intensity Workout I    
  • High Intensity Workout II    
  • Pilates    
  • Stress Management    
  • Tai Chi (Beginner)  
  • Tai Chi (Intermediate)    
  • Walking    
  • Yoga

The Silver&Fit Exercise and Healthy Aging Program is provided to Members on our Thrifty, Standard and Plus plans. To see if your fitness facility is in the network, go to their website at www.SilverandFit.com. By clicking on this link, you will be leaving the RMHP website.

Once you are a Silver&Fit Exercise & Healthy Aging Program Member you may nominate a fitness club or facility to be added to the network by going online at www.SilverandFit.com. By clicking on this link, you will be leaving the RMHP website.


2016 RMHP Western Slope Medicare Cost Plan Information

View a detailed 2016 Summary of Benefits for plans with Medicare Part D Prescription Drug coverage.  English | Español

View a detailed 2016 Summary of Benefits for the Medical-only plans.  English | Español

View a detailed 2016 Summary of Benefits for the AB Basic Plan (Cost), B Basic Plan (Cost), and B Standard Plan (Cost). English

2016 Annual Notice of Change (ANOC)/Evidence of Coverage (EOC)

  • Rocky Mountain Green Plan + Rx (Cost)   English 
  • Rocky Mountain Green Plan (Cost)   English 
  • Rocky Mountain Thrifty Plan + Rx (Cost)   English 
  • Rocky Mountain Thrifty Plan (Cost)   English 
  • Rocky Mountain Standard Plan + Rx (Cost)   English 
  • Rocky Mountain Standard Plan (Cost)   English 
  • Rocky Mountain Plus Plan + Rx (Cost)   English 
  • Rocky Mountain Plus Plan (Cost)   English 
  • Rocky Mountain AB Basic Plan (Cost) English


We have free interpreter services to answer any questions you may have about our health or drug plan. To get an interpreter, just call us at 1‐888‐282‐1420. Someone who speaks English/Language can help you. This is a free service.  Click here to access the Multi-language Interpreter Services information.


The 2016 Evidence of Coverage provides more detailed information about:
  • Conditions associated with receipt or use of benefits, limitations and exclusions.
  • Out-of-network coverage- Members of our plan may get services from out-of-network providers. If you get care from an out-of-network provider that is not Prior Authorized by RMHP, you will pay the cost-sharing amounts under Original Medicare.
  • Grievance, coverage determinations, appeals procedures and exceptions process (For plans with Part D Prescription Drug coverage, see Chapter 9 of the EOC. For medical-only plans, see Chapter 7 of the EOC.)
  • Quality assurance policies and procedures, including medication therapy management, and drug and/or utilization management.
  • Potential for contract termination.
  • Beneficiaries' and plan's rights and responsibilities upon disenrollment.

Counties in the Western Slope Medicare Coverage Service Area: Alamosa, Archuleta, Chaffee, Conejos, Costilla, Delta, Dolores, Eagle, Garfield, Grand, Gunnison, Hinsdale, Jackson, La Plata, Lake, Mesa, Mineral, Moffat, Montezuma, Montrose, Ouray, Pitkin, Rio Blanco, Rio Grande, Routt, Saguache, San Juan, San Miguel and Summit


View a summary of the RMHP grievance, coverage determination (including Medicare Part D exceptions), and appeals processes.


This information is available for free in other languages. Please call our Customer Service number at 888-282-1420 (TTY dial 711). Hours are 8am - 8pm, 7 days/week, Oct. 1–Feb.14, and 8am - 8pm, M-F, Feb.15–Sept.30. Esta información está disponible gratuitamente en otros idiomas. Por favor llame a la línea de Atención a Clientes, al 888-282-1420 (TTY marque 711). Horario  de 8am - 8pm, 7 días a la semana, del 1 de octubre al 14 de febrero; y de 8am - 8pm, de lunes a viernes, del 15 de febrero al 30 de septiembre.

This page was last updated: 4/6/2016.  Please call to confirm you have the most up to date information about our Medicare Cost plans. Medicare Disclaimers

RMHP is a Medicare-approved Cost plan. Enrollment in RMHP depends on contract renewal. H0602_MS_MC400WEB_RMHP3 Approved.