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RMHP Metro Denver Colorado Medicare Thrifty Plans Rocky Mountain Thrifty Plan + Rx (Cost) – $74.30/month Rocky Mountain Thrifty Plan (Cost)* –$25.00/month
You must continue to pay your Medicare Part B premium. * Medical-only plan does not include the Medicare Part D prescription drug plan benefit. RMHP Medical Only plans are open for enrollment at any time. Benefits Include: No plan deductible for Part D Prescription drug coverage Low generic drug copays Emergency and urgent care covered throughout the United States Optional dental plan (for a low additional premium) Optional vision plan (for a low additional premium) Premiums, benefits, formulary, and copayments or coinsurance amounts may change on January 1, 2014. The benefit information provided herein is a brief summary, not a comprehensive description of benefits. For more information contact the RMHP or refer to the Metro Denver RMHP Medicare Plan Highlights Grid for a comparison listing of RMHP Colorado Medicare plan benefits for all plans in the Metro Denver area and comprehensive information on all covered services and costs. Limitations, copayments, and restrictions may apply.
Medicare Covered Benefit	Rocky Mountain Colorado Medicare Thrifty Plan + Rx (Cost) You Pay
Monthly Plan Premium   Medical Only   Prescription Drug	$25.00* $49.30
Total	$74.30* * plus you must continue to pay Medicare Part B premium
Medical Deductible	$500 per calendar year (annual deductible). Applies to all services except Preventive Care, Primary Care Physician and Specialist Care office visits, lab services, and Emergency room services.
Medical out of pocket maximum	$6,000 per calendar year. Amounts you pay for RMHP deductibles, copayments and coinsurance for Medicare-covered services count toward the maximum out-of-pocket amount.
Primary Care Physician Office Visit Copayment	$20 per visit Deductible does not apply
Specialist Care Physician Office Visit Copayment	$50 per visit Deductible does not apply
Inpatient Hospital Copayment	After the $500 annual deductible $200 copay days 1-5 $0  copay days 6-90
Outpatient Surgery	After the $500 annual deductible $400 per visit
Ambulance	$200 per trip Deductible does not apply
Emergency Room	$65 per visit Deductible does not apply
Urgent Care	$50 per visit Deductible does not apply
Part D Prescription Drug Benefit Formulary of prescription drugs covered on the Rocky Mountain Thrifty Plan + Rx (Español) Additional RMHP Part D Information and Forms	No deductible $3  copay Tier 1 $12 copay Tier 2 $45 copay Tier 3 $90 copay Tier 4 33% coinsurance Tier 5 After $2,970 in retail drug expenses, Member pays generally no more than 79% of the price for generic drugs and; 47.5% of the plan’s costs for brand drugs until the member’s yearly out-of-pocket drug costs reach $4,750 After the Member’s out-of-pocket drug costs reach $4,750, they pay: $2.65 copay generic; $6.60 copay for all other drugs;  OR 5% (whichever is higher)
Annual Wellness Visit	$0 Deductible does not apply
Preventive Screening Services	$0 Deductible does not apply
Skilled Nursing Facility	After the $500 annual deductible $0, days 1-20 $100, days 21-100
Durable Medical Equipment	After the$500 annual deductible 20% coinsurance

People with limited incomes may qualify for Extra Help to pay for their prescription drug costs. If you qualify, Medicare could pay for up to seventy-five (75) percent or more of your drug costs, including monthly prescription drug premiums, annual deductibles, and co-insurance. Additionally, those who qualify will not be subject to the coverage gap or a late enrollment penalty. Many people are eligible for these savings and don’t even know it. For more information about this 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 should call 1-800-325-0778; or
• Your State Medicaid Office.

RMHP Medicare Extras:
The products and services described as Extras are neither offered nor guaranteed under our contract with the Medicare program. In addition, they are not subject to the Medicare appeals process. Any disputes regarding these products and services may be subject to the RMHP grievance process.

• Silver&Fit Affinity walking program to support wellness (included)
• Vision discount program (included)
• Hearing discount program (included)
• Discounts on complementary care, for example: chiropractic and massage therapy (included)

View detailed information on Rocky Mountain Medicare Extras offered to our Members.