BlueJourney Alliance Assisted Care (HMO I-SNP)

BlueJourney Alliance Assisted Care (HMO SNP) provides individualized, monitored care to members who live in nursing homes. The plan helps coordinate care through Landmark Health’s nurses and physician assistants. Landmark Health providers review care goals, manage pain, coordinate care, and maintain or increase daily function and quality of life for members.

The plan also provides care to members who live in contracted skilled nursing facilities or assisted living communities and require an institutional level of care. Landmark Health’s nurses work with physicians, facilities, members and members’ families to coordinate care.

About Landmark Health, LLC

Landmark Health, LLC partners with health plans to bring house calls to patients living with multiple chronic conditions. Landmark’s providers – physicians, nurses and physician assistants – go to the homes of patients to help keep them well, and provide urgent care when needed. Landmark does not replace patients’ primary care providers (PCPs). Rather, Landmark’s in-home physicians and advanced practice providers support PCPs. They help patients follow care plans in the home. PCPs are updated with visit notes after each home visit, and are consulted if there are recommended changes to care or medications.

To enroll in a Medicare Special Needs Plan, you must meet the following eligibility requirements:

  • Be enrolled in Medicare Part A and Part B.
  • Live in the service area of the Special Needs Plan.
  • Meet the eligibility requirements that the Special Needs Plan targets (i.e., live in an institution; have Medicare and Medicaid; or have the chronic conditions(s) that the plan targets).

Assisted Care

Enroll Online
Monthly premium
$40
In-network deductible
$0
Primary Care Physician office visits
$10
Physician Specialist
$30
Urgent Care
$40
Inpatient hospital stay
$170 per day for days 1-8
Outpatient surgery $225 copay
Ambulatory Surgical Center
$125 copay
Emergency Care
$120 copay
Lab services
$15 copay
X-Rays
$20 copay
High tech imaging (MRI/CT scan)
$225 copay
Diabetes self-monitoring training and supplies
$0 copay
Hearing services(routine fitting and exam)

$0 copay routine exam

$0 copay fitting every 3 years

Hearing aids
$800 allowance every 3 years
Routine vision (one annual eye exam)
$20 copay (in-network) One eye exam every calendar year

$125 allowance toward eyeglass frames or contact lenses every 2 years

Expanded dental benefits
$10 copay (in-network); cleanings and x-rays covered; two routine visits per calendar year. 50% in-network coinsurance for non-routine, restorative, endodontics and extractions services. $2000 annual allowance
Transportation Services

Limit 24 Round Trips per Contract (Calendar) Year

Mode of Transport: Taxi, Bus/Subway, Van, Medical Transport; arranged by Plan. No Copay
Prescription Drug Benefits $0 deductible
Tier 1 Preferred Generics $0/$10
Tier 2 Generic Drugs $5/$20
Tier 3 Preferred Brand $40/$47
Tier 4 Nonpreferred Drugs $93/$100
Tier 5 Specialty Drugs 33 percent
(30 day supply only)
Tier 6 Select Care Drugs $0/$7
After initial coverage limit reached 25 percent generic
25 percent brand
Part D Excluded Drugs Not covered
Over-the-counter drugs (OTC)
$15 monthly allowance (cannot be carried over from month to month)
Landmark Health
Included
Medical Nutritional Therapy
Included
Nutritional/Dietary Benefit
Included
Health Coaching and Education Benefit
Included

Enroll Online

Other Ways to Enroll

Plan Info

Evidence of Coverage

Summary of Benefits

Annual Notice of Changes

Out of Network Coverage Rules


Web Content Viewer - Fixed Context

Updated November 1, 2019

Y0016_WBST1120