2020 RMHP Dual Special Needs Plans

2020 RMHP Dual Special Needs Plans

RMHP DualCare Plus is a Dual Special Needs Plan available to Mesa County residents who qualify. Learn more about this plan below, then contact RMHP with questions or to enroll.


What is RMHP DualCare Plus?

RMHP DualCare Plus is a Dual Special Needs Plan from RMHP that’s available in 2020 to Mesa County residents who qualify. With an RMHP DualCare Plus plan, we combine your Medicare and Medicaid coverage into one plan. You also receive:

  • Additional benefits beyond Original Medicare
  • Access to a local network of doctors and pharmacies
  • A coordinated care experience
  • Wellness support
  • Answers to your Medicare, Medicaid, prescription, and other benefit questions by calling one phone number
  • Local coordination of your Medicaid benefits by the same RMHP team

2020 RMHP DualCare Plus Plan Benefits

For complete information, download the RMHP DualCare Plus Summary of Benefits or Evidence of Coverage (EOC).

Download this Benefit Grid

Download the RMHP DualCare Plus Summary of Benefits

Download the RMHP DualCare Plus EOC

Monthly Plan Premium $0 with full "Extra Help" Up to $31.30, depending on your level of "Extra Help"

Your plan has a deductible that applies to certain medical benefits. For complete information, please refer to your Summary of Benefits or Evidence of Coverage.

Benefit With Medicaid Cost Share Assistance Without Medicaid Cost Share Assistance
Part B Deductible $0 for Medicare Part B Services with Medicaid cost-share assistance $185* for Medicare Part B services without Medicaid costshare assistance
Annual out-of-pocket maximum (The most you may pay in a year for medical care covered by the plan) $0 $6,700
Doctors Office Visit Primary Care Provider: $0 copay;
Specialist: $0 copay (no referral needed)
Primary Care Provider: 20% Coinsurance; 
Specialist: 20% coinsurance (no referral needed)
Preventive Services $0 copay $0 copay
Inpatient Hospital Care $0 copay per stay for unlimited days $1,364* deductible for days 1 to 60;
$341 copay each day for days 61 to 90;
$0 copay per day for unlimited days after that**
Skilled Nursing Facility (SNF) $0 copay per day: days 1-100 $0 copay per day: days 1-20;
$170.50* copay per day: days 21-100
Outpaitent Hospital, including Surgery $0 copay $0 copay - 20% coinsurance; 
Cost sharing for additional plan covered services will apply
Diabetes Monitoring Supplies $0 copay for covered brands $0 copay for covered brands
Home Health Care $0 copay $0 copay
Diagnostic Radiology Services (such as MRI's, CT Scans) $0 copay 20% coinsurance
Diagnostic Tests and Procedures (nonradiological) $0 copay 20% coinsurance
Lab Services $0 copay $0 copay
Outpaitent X-rays $0 copay 20% coinsurance
Ambulance $0 copay for ground;
$0 copay for air
20% coinsurance for ground;
20% coinsurance for air
Emergency Care $0 copay (worldwide) $90 copay ($0 copay for worldwide coverage)
Urgently Needed Services $0 copay (worldwide) $65 copay ($0 copay for worldwide coverage)

 

*These are the 2019 Medicare defined amounts and may change for 2020.

**Different rules apply for inpatient mental health coverage. See your Evidence of Coverage for details.

Benefit Your Cost
Routine Physical $0 copay, 1 per year
Vision - Routine Eye Exams $0 copay every 2 years; up to $200 for lenses, frames & contacts
Dental - Preventive $0 copay for exams, cleanings, x-rays, and fluoride
Dental - Comprehensive $0 copay for comprehensive dental services
Dental - Benefit Limit $500 limit per year on all covered dental services
Hearing - Routine Exam $0 copay; per 1 year
Hearing Aids $2000 credit for hearing aids; up to 2 hearing aids every 2 years
Fitness program through Renew ActiveTM Standard membership to participating fitness locations with access to group fitness classes – depending on availability. Programs such as online brain exercises, activities and an in-person fitness orientation at no cost to you. For the complete details about the program, please visit www.UHCRenewActive.com, and click the link in the footer entitled Terms and Conditions
Personal Emergency Response System With the Personal Emergency Response System (PERS) help is only a button away. You can have peace of mind knowing that in any emergency situation the PERS in-home monitoring device can get you help quickly, 24 hours a day at no additional cost. The device is a lightweight button that can be worn on your wrist or as a pendant and may automatically detect falls depending on the model chosen. You must have a working landline and/or cellular phone coverage to take part in this benefit.
Foot Care - Routine $0 copay; 4 visits per year
Health Products Benefit $50 credit per quarter to use on approved health products

If you qualify for Low-Income Subsidy (LIS) you pay:

Benefit Your Cost
Annual Prescription Deductible $0 or $89, depending on the level of "Extra Help" you receive

 

30-day supply from retail network pharmacy
Generic Prescription Drugs (including Brand Drugs treated as Generic; 30-day supply from Retail network Pharmacy) $0, $1.30, $3.60 copay, or 15% coinsurance
All other drugs (30-day supply from Retail network Pharmacy) $0, $3.90, $8.95 copay, or 15% coinsurance

 

If you don't qualify for Low-Income Subsidy (LIS) you pay:

Benefit Your Cost
Annual Prescription Deductible $435
Cost-sharing for Covered Drugs Standard Retail (30 days) Mail Order (90 days)
Initial coverage stage 25% coinsurance 25% coinsurance
Coverage Gap Stage After your total drug costs reach $4,020, you will pay no more than 25% coinsurance for generic drugs or 25% coinsurance for brand name drugs, for any drug tier during the coverage gap

 

If you don't qualify for Low-Income Subsidy (LIS) you pay:

Benefit Your Cost
Catastrophic coverage stage After your total out-of-pocket costs reach $6,350, you will pay the greater of $3.60 copay for generic (Including brand drugs treated as generic), $8.95 copay for all other drugs, or 5% coinsurance

Do I Qualify for RMHP DualCare Plus?

You may be eligible to enroll in RMHP DualCare Plus if you answer ‘yes’ to these questions:

  1. Do you qualify for Colorado Medicaid benefits?
    • You are under age 65 and qualify on the basis of disability or other special situation
    • You are at least 65 years old and receive Extra Help or assistance from your state
    • You must have full Medicaid benefits to qualify for RMHP DualCare Plus. A licensed sales agent can help answer your questions about eligibility.
  2. Do you have Medicare Parts A and B?
    • You’re at least 65 years old, or you’re under 65 and qualify on the basis of disability or other special situations and
    • You’re a United States Citizen or a legal resident who has lived in the United States for at least five consecutive years
  3. Do you live in RMHP’s DualCare Plus service area?
    • You must live in Mesa County to qualify for this plan. A licensed sales agent can help answer your questions about the service area.
  4. Do you meet the health requirements?
    • This plan is not for individuals who have end-stage kidney failure, also called end-stage renal disease (ESRD).

Prescription Drug Information for Your RMHP DualCare Plus Plan

RMHP DualCare includes Medicare Part D prescription drug coverage.

RMHP DualCare covers a wide variety of medications. You can review our formulary, or list of covered drugs, to see if your medication is covered. You can also request a printed formulary at no cost by calling RMHP Customer Service at 800-346-4643 (TTY: 711).

Review the DualCare Formulary

Search the DualCare Formulary

You can find a network pharmacy by using our convenient online search. You can also request a printed list of pharmacies near you at no cost by contacting RMHP Customer Service at 800-346-4643 (TTY: 711). RMHP is also proud to work with OptumRx to provide home delivery services for medications you use on a regular basis.

Find a Pharmacy

Sometimes, the prescription you take isn’t on your plan’s drug list, or it’s subject to certain limits. Start by talking to your doctor to see if there’s another medication on the drug list that you can switch to. If there isn’t an appropriate alternative drug, you or your doctor can ask for a formulary exception. Contact RMHP Customer Service to request a formulary exception. If it’s approved, you can continue taking your current medication for a certain period of time.

Whether you’re switching drugs or waiting for an exception approval, you may be eligible for a transition supply of your current drug.

  • You must get your 1-month supply, as described in your Evidence of Coverage (EOC), during the first 90 days with the plan as a new member.
  • You may also be eligible for a one-time, temporary 1-month supply if you qualify for an emergency fill while residing in a long-term care (LTC) facility after the first 90 days as a new member or you have encountered a level of care change.
  • If your doctor writes your prescription for fewer days, you may refill the drug until you’ve received at least a 1-month supply, as described in your EOC.

You may be eligible for a temporary supply of prescription drugs if:

  • You are a new Member and it’s during the first 90 days of your membership in the plan
  • You have been in the plan for more than 90 days and reside in a long-term care (LTC) facility and need a supply right away
  • You have a level of care change at any time during the plan year (for example: going into a long term care facility from a hospital, going home from a hospital stay, or going home from a long term care facility stay)

Be sure to review your EOC for details.

Prescriptions can be expensive. The Extra Help program offered by Medicare is for individuals with low incomes and limited assets. This is also called Low Income Subsidy or LIS. To qualify for Extra Help, a person must be receiving Medicare, have limited resources and income, and reside in one of the 50 states or the District of Columbia.

To see if you qualify or for more information, call Social Security at 800-772-1213 (TTY: 800-325-0778) or visit their website by selecting the button below.

Learn more about Extra Help

(By selecting this link, you will be leaving rmhp.org)

As part of the UnitedHealthcare family of plans, RMHP works with closely with UnitedHealthcare. Eligible RMHP Members can participate in UnitedHealthcare’s Medication Therapy Management (MTM) program. This program helps qualifying Members understand their coverage and how to use their medications. It can also help identify possible risks of side effects and potentially harmful drug combinations. There is no cost to this program.

Members will automatically be enrolled in the MTM program if you:

  • take eight (8) or more chronic Part D medications, and
  • have three (3) or more long-term health conditions, and
  • are likely to spend more than $4,044 a year on covered Part D medications

You also must have three or more of these health conditions to qualify for the program:

  • Diabetes
  • Hypertension (High Blood Pressure)
  • Heart Failure
  • High Cholesterol
  • Rheumatoid Arthritis

Within 60 days of becoming eligible, you'll receive an offer by mail or phone to complete a Comprehensive Medication Review (CMR).

You can complete the CMR by phone or in person with a qualified health care provider. It takes about 30 minutes. A pharmacist, or qualified CMR provider, will review your medication history, including prescription and over-the-counter medications, and look for any issues.

Within 14 days of the CMR, you'll receive a Medication Action Plan. It summarizes any clinical concerns and a Personal Medication List of your medication history. This can be helpful when meeting with your doctor or pharmacist. The results may also be sent to your doctor.

In addition to the CMR, Targeted Medication Reviews are completed at least quarterly. These reviews are done to find any drug-to-drug interactions or other medication concerns and will be sent to your doctor. The MTM program is not a plan benefit. For more information about the MTM program, contact RMHP Customer Service.

How Do I Enroll in RMHP DualCare Plus?

RMHP is here to help! Here’s how you can enroll in an RMHP DualCare Plus plan:

Call 800-462-8763 (TTY: 711) to speak with a licensed sales representative. Hours are 8am-8pm Monday – Sunday, October 1-March 31 and 8am-8pm Monday – Friday, April 1-September 30.

We make it easy to download and print our application. Complete the form, then send it back to us.

Mail
Rocky Mountain Health Plans
P.O. Box 30770
Salt Lake City, UT 84130-0770

Fax
888-950-1170

Download the Enrollment Request Form

Stop by our office to speak with a licensed sales representative. No appointment is necessary. Hours are 8:00 a.m. – 5:00 p.m., Monday – Friday.

RMHP Enrollment Center Ward Building
2779 Crossroads Boulevard
Grand Junction, CO 81506

Star Rating

RMHP’s Medicare D-SNP Plan is too new to be measured. Every year Medicare evaluates plans based on a 5-Star rating system.

View our D-SNP Star Rating details (English)

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Medicare Disclaimer

This page was last updated: 10/01/2019.  Please call to confirm you have the most up to date information about our Medicare plans. 

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Important Disclaimers: RMHP is a Medicare-approved Cost plan. Enrollment in RMHP depends on contract renewal. Plans are insured through UnitedHealthcare Insurance Company or one of its affiliated companies, a Medicare Advantage organization with a Medicare contract and a contract with the State Medicaid Program.  Enrollment in the plan depends on the plan's contract renewal with Medicare. Other pharmacies, physicians, providers are available in our network. For a complete list of available plans please contact 1-800-MEDICARE (TTY users should call 1-877-486-2048), 24 hours a day/7 days a week or consult www.medicare.gov. Every year, Medicare evaluates plans based on a 5-star rating system. If you need help finding a network provider, please call 888-282-1420 (TTY 711) or visit www.rmhpMedicare.org to access our online searchable directory. If you would like a provider directory mailed to you, you may call the number above, request one at the website link provided above, or email customer_service@rmhp.org.

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